Provider Demographics
NPI:1972661312
Name:BONSU, OSEI A (DO)
Entity Type:Individual
Prefix:
First Name:OSEI
Middle Name:A
Last Name:BONSU
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 HOSPITAL DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:GALAX
Mailing Address - State:VA
Mailing Address - Zip Code:24333-2454
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:199 HOSPITAL DR
Practice Address - Street 2:SUITE 5
Practice Address - City:GALAX
Practice Address - State:VA
Practice Address - Zip Code:24333-2454
Practice Address - Country:US
Practice Address - Phone:276-236-6136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHRT 4889207R00000X
VA0102202065207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1972661312Medicaid
015034C87Medicare PIN
VA1972661312Medicaid
VA015035C86Medicare PIN
015246C63Medicare PIN
016571C40Medicare PIN