Provider Demographics
NPI:1770914590
Name:BONAGURA, ANTHONY FRANCIS (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:FRANCIS
Last Name:BONAGURA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:373 MOYER BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454-2725
Mailing Address - Country:US
Mailing Address - Phone:215-699-5890
Mailing Address - Fax:
Practice Address - Street 1:373 MOYER BLVD
Practice Address - Street 2:
Practice Address - City:NORTH WALES
Practice Address - State:PA
Practice Address - Zip Code:19454-2725
Practice Address - Country:US
Practice Address - Phone:215-699-5890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-04
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD048821L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine