Individual
WAYNE RUSSSELL BONLIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
30 E PADONIA RD, SUITE 305, TIMONIUM, MD 21093-2345
(410) 560-7404
(443) 588-1725
Mailing address
30 E PADONIA RD, SUITE 305, TIMONIUM, MD 21093-2345
(410) 560-7404
(443) 588-1725
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
D0062606
MD
Other
Enumeration date
04/20/2006
Last updated
01/26/2016
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