Provider Demographics
NPI:1801997960
Name:BONNER, EILEEN MARITA (MD)
Entity type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:MARITA
Last Name:BONNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:809 JUDIE LN
Mailing Address - Street 2:
Mailing Address - City:LOWER GWYNEDD
Mailing Address - State:PA
Mailing Address - Zip Code:19002-2622
Mailing Address - Country:US
Mailing Address - Phone:215-542-7609
Mailing Address - Fax:215-785-7227
Practice Address - Street 1:3100 STATE RD
Practice Address - Street 2:
Practice Address - City:CROYDON
Practice Address - State:PA
Practice Address - Zip Code:19021-6967
Practice Address - Country:US
Practice Address - Phone:215-785-7061
Practice Address - Fax:215-785-7227
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD029078E2083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine