Provider Demographics
NPI:1336354745
Name:BONNER MILLAR, LARA P (MD)
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:P
Last Name:BONNER MILLAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-388-3483
Mailing Address - Fax:757-627-0334
Practice Address - Street 1:600 GRESHAM DR
Practice Address - Street 2:RADIATION ONCOLOGY
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1904
Practice Address - Country:US
Practice Address - Phone:757-388-3483
Practice Address - Fax:757-627-0334
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA01012518932085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1336354745OtherCOVENTRY HEALTH NETWORK
VAPAROtherCIGNA
VAPAROtherUSA MANAGED CARE
VAPAROtherVIRGINIA HEALTH NETWORK
VAPAROtherCORVEL
VA1336354745Medicaid
NC5920365Medicaid
VA10092625OtherOPTIMA HEALTH
VA1336354745OtherUNITED HEALTHCARE
VAPAROtherMULTIPLAN
VA470158OtherANTHEM BC/BS
VA1336354745OtherTRICARE
VA1336354745OtherVIRGINIA PREMIER HEALTH PLAN
VAPAROtherAETNA
VA1336354745Medicaid