Provider Demographics
NPI:1679541379
Name:BOHNER, MARY F (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:F
Last Name:BOHNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 ORCHARD DR
Mailing Address - Street 2:UNIVERSITY CENTER @ LEVEL GREEN
Mailing Address - City:TRAFFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15085-1640
Mailing Address - Country:US
Mailing Address - Phone:412-856-7332
Mailing Address - Fax:
Practice Address - Street 1:101 ORCHARD DR
Practice Address - Street 2:UNIVERSITY CENTER @ LEVEL GREEN
Practice Address - City:TRAFFORD
Practice Address - State:PA
Practice Address - Zip Code:15085-1640
Practice Address - Country:US
Practice Address - Phone:412-856-7332
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD025925E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE63602Medicare UPIN
PA129144PD9Medicare ID - Type Unspecified