Provider Demographics
NPI:1790863058
Name:BONNEY, WARREN KENT (MD)
Entity Type:Individual
Prefix:
First Name:WARREN
Middle Name:KENT
Last Name:BONNEY
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 1:530 W WEBB AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27217
Mailing Address - Country:US
Mailing Address - Phone:336-228-8316
Mailing Address - Fax:336-227-9750
Practice Address - Street 1:3804 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-9134
Practice Address - Country:US
Practice Address - Phone:336-524-0304
Practice Address - Fax:336-584-4387
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9801600208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8911845Medicaid
NC1184JOtherBCBS
NC1208053OtherUHC
NC1208053OtherUHC