Provider Demographics
NPI:1619973534
Name:BONAVENTE, ARNULFO B (MD)
Entity Type:Individual
Prefix:DR
First Name:ARNULFO
Middle Name:B
Last Name:BONAVENTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10403 HOSPITAL DR
Mailing Address - Street 2:STE G4
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-3137
Mailing Address - Country:US
Mailing Address - Phone:301-856-3019
Mailing Address - Fax:301-856-9370
Practice Address - Street 1:6409 CRAIN HWY
Practice Address - Street 2:ROUTE 301
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-4139
Practice Address - Country:US
Practice Address - Phone:301-952-8614
Practice Address - Fax:301-627-1603
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0045630207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF96804Medicare UPIN
DCB776-0004OtherBCBS DC
MD53527203OtherBCBS MD
MD80117503OtherRAILROAD MEDICARE
DC47637M16Medicare PIN
MD1427093343OtherGROUP NPI
MDF96804Medicare UPIN
MD355900900Medicaid