Provider Demographics
NPI:1013976414
Name:BONSU, JOYCE A (MD)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:A
Last Name:BONSU
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 1:3449 WILKENS AVE STE 305
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-5218
Mailing Address - Country:US
Mailing Address - Phone:410-644-2582
Mailing Address - Fax:410-644-6232
Practice Address - Street 1:3449 WILKENS AVE STE 305
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-5218
Practice Address - Country:US
Practice Address - Phone:410-644-2582
Practice Address - Fax:410-644-6232
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0059784207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD401434100Medicaid
MD618993-03OtherCAREFIRST-MD
MD0040OtherCAREFIRST-DC
MD401434100Medicaid
MD539P091HMedicare PIN