Provider Demographics
NPI:1558381533
Name:BONFIGLIO, THOMAS A (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:A
Last Name:BONFIGLIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 626
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-2945
Mailing Address - Country:US
Mailing Address - Phone:585-275-1699
Mailing Address - Fax:585-276-2047
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:BOX 626
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-2945
Practice Address - Country:US
Practice Address - Phone:585-275-1699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY109551-1207ZC0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY75269Medicare UPIN
NYRB2911Medicare PIN