Individual
MS. MARY M BONOMO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
5501 OLD YORK RD, KLEIN 510, PHILADELPHIA, PA 19141-3018
(215) 456-6933
Mailing address
5501 OLD YORK RD, KLEIN 510, PHILADELPHIA, PA 19141-3018
(215) 456-6933
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
MA051566
PA
Other
Enumeration date
05/11/2010
Last updated
05/11/2010
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