Provider Demographics
NPI:1811177041
Name:BONNIE L. BURNQUIST, M.D., P.A.
Entity type:Organization
Organization Name:BONNIE L. BURNQUIST, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BURNQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-537-6110
Mailing Address - Street 1:71 OMEGA DR
Mailing Address - Street 2:BUILDING D
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2063
Mailing Address - Country:US
Mailing Address - Phone:302-283-3300
Mailing Address - Fax:302-283-3321
Practice Address - Street 1:118 ATLANTIC AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:OCEAN VIEW
Practice Address - State:DE
Practice Address - Zip Code:19970-9163
Practice Address - Country:US
Practice Address - Phone:302-537-6110
Practice Address - Fax:302-537-4666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10007200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEDD5725OtherRAILROAD
F72630Medicare UPIN
DEG01967Medicare PIN