Provider Demographics
NPI:1396829628
Name:BONELLI, JOSE F (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:F
Last Name:BONELLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8807 COLESVILLE RD
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910
Mailing Address - Country:US
Mailing Address - Phone:301-608-3835
Mailing Address - Fax:301-608-3837
Practice Address - Street 1:8807 COLESVILLE RD
Practice Address - Street 2:5TH FLOOR
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4346
Practice Address - Country:US
Practice Address - Phone:301-608-3835
Practice Address - Fax:301-608-3837
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0035055207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD484321500Medicaid
C89078Medicare UPIN
MD484321500Medicaid