Individual
DR. BRIAN K. BONHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
22911 JEFFERSON BLVD, SMITHSBURG, MD 21783-1617
(301) 824-3343
(301) 824-6323
Mailing address
22911 JEFFERSON BLVD, SMITHSBURG, MD 21783-1617
(301) 824-3343
(301) 824-6323
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
D0054451
ME
208000000X
Pediatrics Physician
Primary
D0054451
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
507200000
—
MD
Enumeration date
04/18/2006
Last updated
10/17/2013
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