Provider Demographics
NPI:1508815283
Name:PEREZ-BONNELLY, MANUEL EDUARDO (MD)
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:EDUARDO
Last Name:PEREZ-BONNELLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1777 REISTERSTOWN RD
Mailing Address - Street 2:SUITE 222
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-1306
Mailing Address - Country:US
Mailing Address - Phone:410-415-0933
Mailing Address - Fax:410-415-0935
Practice Address - Street 1:1777 REISTERSTOWN RD
Practice Address - Street 2:SUITE 222
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-1306
Practice Address - Country:US
Practice Address - Phone:410-415-0933
Practice Address - Fax:410-415-0935
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0067680207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I27649Medicare UPIN
MD132306ZAVXMedicare PIN