Provider Demographics
NPI:1578564209
Name:BONNER, JAMES JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:JOSEPH
Last Name:BONNER
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 1:1940 N 13TH ST
Mailing Address - Street 2:STE 207
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19604-1539
Mailing Address - Country:US
Mailing Address - Phone:610-921-9751
Mailing Address - Fax:610-921-2681
Practice Address - Street 1:1940 N 13TH ST
Practice Address - Street 2:STE 207
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19604-1539
Practice Address - Country:US
Practice Address - Phone:610-921-9751
Practice Address - Fax:610-921-2681
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-031858-E207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
02337100OtherCAPITAL BLUE CROSS
0991448OtherKEYSTONEHEALTHPLANCENTRAL
249554OtherMAMSI
01163701OtherCAPITAL BLUE CROSS
B0128492OtherHIGHMARK BLUE SHIELD
0027861OtherAETNA
PA0011009870001Medicaid
249554OtherMAMSI
PA0011009870001Medicaid