Provider Demographics
NPI:1821051632
Name:BONNETT, KATHRYN A (MD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:A
Last Name:BONNETT
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 1:1822 GOOD HOPE RD
Mailing Address - Street 2:
Mailing Address - City:ENOLA
Mailing Address - State:PA
Mailing Address - Zip Code:17025-1233
Mailing Address - Country:US
Mailing Address - Phone:717-763-7685
Mailing Address - Fax:717-975-2950
Practice Address - Street 1:1822 GOOD HOPE RD
Practice Address - Street 2:
Practice Address - City:ENOLA
Practice Address - State:PA
Practice Address - Zip Code:17025-1233
Practice Address - Country:US
Practice Address - Phone:717-763-7685
Practice Address - Fax:717-975-2950
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD055933L207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PABO708727OtherHIGHMARK BLUE SHIELD
PA50047360OtherCAPITAL BLUE CROSS
PA50047360OtherCAPITAL BLUE CROSS
PAGO4218Medicare UPIN
PAGO4218Medicare UPIN
PA0015188580001Medicaid