Provider Demographics
NPI:1821086646
Name:BONNER, LLOYD ARDEN (MD)
Entity Type:Individual
Prefix:DR
First Name:LLOYD
Middle Name:ARDEN
Last Name:BONNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:505 W LEIGH ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-3200
Mailing Address - Country:US
Mailing Address - Phone:804-644-1333
Mailing Address - Fax:804-782-1193
Practice Address - Street 1:505 W LEIGH ST
Practice Address - Street 2:SUITE 303
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-3200
Practice Address - Country:US
Practice Address - Phone:804-644-1333
Practice Address - Fax:804-782-1193
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101029472207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06695OtherGROUP PTAN
VA6078401Medicaid
VAC06695OtherGROUP PTAN
VA112950756Medicare PIN