Provider Demographics
NPI:1538108816
Name:BONIFACE, JAMES EUGENE (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:EUGENE
Last Name:BONIFACE
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 1:740 E STATE ST
Mailing Address - Street 2:SHARON REGIONAL PHYSICIAN SERVICES
Mailing Address - City:SHARON
Mailing Address - State:PA
Mailing Address - Zip Code:16146-3328
Mailing Address - Country:US
Mailing Address - Phone:724-983-5584
Mailing Address - Fax:724-983-5611
Practice Address - Street 1:2151 SHENANGO VALLEY FWY
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-2586
Practice Address - Country:US
Practice Address - Phone:724-983-5584
Practice Address - Fax:724-981-2555
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH35062152207X00000X
PAMD447324207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0929142Medicaid
OH0170960001Medicare NSC
OHH150291Medicare PIN
OH0929142Medicaid