Provider Demographics
NPI:1184885329
Name:BONICA, VALERIE (DO)
Entity type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:
Last Name:BONICA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:321 W GIRARD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19123-1531
Mailing Address - Country:US
Mailing Address - Phone:215-685-3803
Mailing Address - Fax:215-685-3816
Practice Address - Street 1:500 S BROAD ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146-1613
Practice Address - Country:US
Practice Address - Phone:215-685-6790
Practice Address - Fax:215-685-6732
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT012330207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine