Provider Demographics
NPI:1639486061
Name:JOSE F. BONELLI, M.D.P.C.
Entity Type:Organization
Organization Name:JOSE F. BONELLI, M.D.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:F
Authorized Official - Last Name:BONELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-608-3833
Mailing Address - Street 1:8807 COLESVILLE RD
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-4346
Mailing Address - Country:US
Mailing Address - Phone:301-608-3833
Mailing Address - Fax:
Practice Address - Street 1:8807 COLESVILLE RD
Practice Address - Street 2:5TH FLOOR
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4346
Practice Address - Country:US
Practice Address - Phone:301-608-3833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0035055173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty