Provider Demographics
NPI:1477514834
Name:STRAKA, BONNIE FOSTER (MD)
Entity Type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:FOSTER
Last Name:STRAKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3350 BERKMAR DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-1491
Mailing Address - Country:US
Mailing Address - Phone:434-923-4651
Mailing Address - Fax:
Practice Address - Street 1:3350 BERKMAR DRIVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901
Practice Address - Country:US
Practice Address - Phone:434-923-4651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101042830207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA070015381OtherMEDICARE RAILROAD
VA700215299OtherCIGNA
VA140449OtherANTHEM BC/BS
VA26982700001OtherSOUTHERN HEALTH
VA005900310OtherVIRGINIA PREMIER
VA005900310Medicaid
VA700215299OtherCIGNA
VA140449OtherANTHEM BC/BS