Provider Demographics
NPI:1295750966
Name:BONACCI, DAVID DAMIAN (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:DAMIAN
Last Name:BONACCI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:104 FOUR WINDS ROAD
Mailing Address - Street 2:
Mailing Address - City:PETERBOROUGH
Mailing Address - State:NH
Mailing Address - Zip Code:03458
Mailing Address - Country:US
Mailing Address - Phone:603-924-6484
Mailing Address - Fax:
Practice Address - Street 1:36 CLINTON STREET
Practice Address - Street 2:NEW HAMPSHIRE HOSPITAL
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301
Practice Address - Country:US
Practice Address - Phone:603-271-5300
Practice Address - Fax:603-271-5395
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH91802084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
B71809Medicare UPIN