Provider Demographics
NPI:1265552244
Name:BONAFINO, GEORGE (DO)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:BONAFINO
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 1:637 S 52ND ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-2630
Mailing Address - Country:US
Mailing Address - Phone:215-472-3500
Mailing Address - Fax:215-471-9087
Practice Address - Street 1:637 S 52ND ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19143-2630
Practice Address - Country:US
Practice Address - Phone:215-472-3500
Practice Address - Fax:215-471-9087
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0S3925L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine