Provider Demographics
NPI:1497482855
Name:BONINO, MARIA MADELEINE (PA-C)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:MADELEINE
Last Name:BONINO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3555 OLENTANGY RIVER RD STE 1080
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3984
Mailing Address - Country:US
Mailing Address - Phone:614-268-8164
Mailing Address - Fax:
Practice Address - Street 1:3555 OLENTANGY RIVER RD STE 1080
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3984
Practice Address - Country:US
Practice Address - Phone:614-268-8164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-05
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.008053RX363A00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist