Provider Demographics
NPI:1467960559
Name:BONHAM, GERALDINE BERGER
Entity Type:Individual
Prefix:MS
First Name:GERALDINE
Middle Name:BERGER
Last Name:BONHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:GERALDINE
Other - Middle Name:
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1160 1ST ST NE APT 308
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-4699
Mailing Address - Country:US
Mailing Address - Phone:202-615-1078
Mailing Address - Fax:
Practice Address - Street 1:1160 1ST ST NE APT 308
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-4699
Practice Address - Country:US
Practice Address - Phone:202-615-1078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-11
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC1449593Medicaid