Provider Demographics
NPI:1295704161
Name:BONTA, MARCO J (MD)
Entity type:Individual
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First Name:MARCO
Middle Name:J
Last Name:BONTA
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Gender:
Credentials:MD
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Mailing Address - Street 1:5450 FRANTZ RD STE 360
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-4141
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3555 OLENTANGY RIVER RD
Practice Address - Street 2:RIVERSIDE TRAUMA SERVICES SUITE 13617
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3912
Practice Address - Country:US
Practice Address - Phone:614-566-2540
Practice Address - Fax:614-566-6692
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2025-05-04
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Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH350493312086S0129X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0700469Medicaid
OHBO0612798Medicare PIN