Provider Demographics
NPI:1578559373
Name:BONAR, ADOLPHUS SOLOMON (MD)
Entity Type:Individual
Prefix:
First Name:ADOLPHUS
Middle Name:SOLOMON
Last Name:BONAR
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 1:2544 COURT DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-3450
Mailing Address - Country:US
Mailing Address - Phone:704-671-6400
Mailing Address - Fax:704-671-6449
Practice Address - Street 1:2544 COURT DR
Practice Address - Street 2:SUITE A
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-3450
Practice Address - Country:US
Practice Address - Phone:704-671-6400
Practice Address - Fax:704-671-6449
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200401176207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCN01176Medicaid
NCP00334281OtherRAILROAD MEDICARE
NC89138FHMedicaid
NCG41675Medicare UPIN
NC2034450Medicare UPIN