Provider Demographics
NPI:1467772236
Name:RICHARDS, BONNIE J (DO)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:J
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:J
Other - Last Name:BOWEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:3131 PRINCETON PIKE
Mailing Address - Street 2:BUILDING 5 SUITE 208
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648
Mailing Address - Country:US
Mailing Address - Phone:609-815-7829
Mailing Address - Fax:309-815-7894
Practice Address - Street 1:555 HIGH ST STE 16A
Practice Address - Street 2:
Practice Address - City:MOUNT HOLLY
Practice Address - State:NJ
Practice Address - Zip Code:08060-1084
Practice Address - Country:US
Practice Address - Phone:609-444-5610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-03
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB09277300207Q00000X
PAOT013460207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine