Provider Demographics
NPI:1831271402
Name:BONVENTRE, EUGENE VINCENT (MD)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:VINCENT
Last Name:BONVENTRE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2109 12TH PL NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-7510
Mailing Address - Country:US
Mailing Address - Phone:703-697-0561
Mailing Address - Fax:703-693-0729
Practice Address - Street 1:PENTAGON FLIGHT MEDICINE CLINIC
Practice Address - Street 2:1760 AIR FORCE PENTAGON ROOM 4A674
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20330-1760
Practice Address - Country:US
Practice Address - Phone:703-697-3255
Practice Address - Fax:703-614-1663
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL2083A0100X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgery