Provider Demographics
NPI:1487652038
Name:BONTEMPO, CARL P (MD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:P
Last Name:BONTEMPO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 37174
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3174
Mailing Address - Country:US
Mailing Address - Phone:703-698-8525
Mailing Address - Fax:703-849-1918
Practice Address - Street 1:3300 GALLOWS RD
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-3307
Practice Address - Country:US
Practice Address - Phone:703-776-4001
Practice Address - Fax:703-776-7113
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101020737207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
486335OtherAETNA HMO
541042964OtherHEALTHNET/TRICARE/CHAMPUS
060005779OtherMEDICARE RAILROAD
541042964OtherCIGNA PPO
502853OtherNCPPO
6975-0002OtherCAREFIRST BC/BS
VA006060986Medicaid
4091345OtherAETNA PPO
011551OtherANTHEM/TRIGON BCBS
22447OtherMAMSI/ALLIANCE
541042964OtherKAISER
541042964OtherPHCS