Provider Demographics
NPI:1912064536
Name:BONWIT, ANDREW M (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:M
Last Name:BONWIT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:55 ROUTE 130
Mailing Address - Street 2:P O BOX 549
Mailing Address - City:FORESTDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02644-1434
Mailing Address - Country:US
Mailing Address - Phone:508-477-5306
Mailing Address - Fax:508-477-0297
Practice Address - Street 1:55 ROUTE 130
Practice Address - Street 2:
Practice Address - City:FORESTDALE
Practice Address - State:MA
Practice Address - Zip Code:02644-1434
Practice Address - Country:US
Practice Address - Phone:508-477-5306
Practice Address - Fax:508-477-0297
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2024-02-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA290530208000000X
IL036117177208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
A55841Medicare UPIN