Individual
CHARLES BONGIORNO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3401 N BROAD ST, PHILADELPHIA, PA 19140-5103
(215) 707-9900
(215) 707-3831
Mailing address
2450 W HUNTING PARK AVE, PHILADELPHIA, PA 19129-1302
(215) 707-9900
(215) 707-3831
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
MD025380E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001041536
—
PA
01
—
1007278000114
MEDICAID TPI GROUP
PA
01
—
597586
MEDICARE TPI GROUP
PA
01
—
CD4829
RAILROAD MEDICARE TPI GROUP
PA
Enumeration date
03/27/2006
Last updated
03/23/2018
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