Provider Demographics
NPI:1609864453
Name:KREMPEL-PORTIER, BONITA J (DO)
Entity Type:Individual
Prefix:DR
First Name:BONITA
Middle Name:J
Last Name:KREMPEL-PORTIER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:BONITA
Other - Middle Name:J
Other - Last Name:PORTIER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:114 E. MAIN STREET
Mailing Address - Street 2:P.O. BOX 1219
Mailing Address - City:EMMITSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21727
Mailing Address - Country:US
Mailing Address - Phone:301-447-3310
Mailing Address - Fax:
Practice Address - Street 1:121 W. MAIN STREET
Practice Address - Street 2:
Practice Address - City:EMMITSBURG
Practice Address - State:MD
Practice Address - Zip Code:21727
Practice Address - Country:US
Practice Address - Phone:301-447-3310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-06
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0044037207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH0044037OtherLICENSE
MD331811700Medicaid
MD205RMedicare PIN
MDF89002Medicare UPIN
PA048773Medicare PIN