Provider Demographics
NPI:1740255744
Name:CALOMENI, CORALIA BONATSOS (MD)
Entity type:Individual
Prefix:
First Name:CORALIA
Middle Name:BONATSOS
Last Name:CALOMENI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CORALIA
Other - Middle Name:
Other - Last Name:BONATSOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 5579
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97708-5579
Mailing Address - Country:US
Mailing Address - Phone:541-706-4701
Mailing Address - Fax:541-706-4751
Practice Address - Street 1:2500 NE NEFF RD
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6015
Practice Address - Country:US
Practice Address - Phone:541-706-4701
Practice Address - Fax:541-706-4751
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD28473207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500601982Medicaid
ORR146655Medicare PIN
CC5033Medicare PIN
B80884Medicare UPIN
54N9285471Medicare PIN
CC5022Medicare PIN
54N921Medicare PIN
900003641Medicare PIN
OR500601982Medicaid