Provider Demographics
NPI:1649259417
Name:CORLEY, BONNIE SIERRA (MD)
Entity type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:SIERRA
Last Name:CORLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 BROWN ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-4671
Mailing Address - Country:US
Mailing Address - Phone:252-975-1188
Mailing Address - Fax:252-975-3800
Practice Address - Street 1:1897 OHIO DR
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-4839
Practice Address - Country:US
Practice Address - Phone:614-875-1721
Practice Address - Fax:614-820-2337
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2002-00671207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2578581Medicaid
OH262648439OtherCOMMERCIAL
OH000000591600OtherANTHEM
OH262648439028OtherCARESOURCE
OHP00311905OtherMEDICARE PTAN
OHH17744Medicare UPIN
4158955Medicare PIN