Individual
BONNIE KY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3400 CIVIC CENTER BOULEVARD, EAST PAVILION, 2ND FLOOR, PHILADELPHIA, PA 19104-4306
(215) 615-4949
(215) 615-0829
Mailing address
3400 CIVIC CENTER BOULEVARD, EAST PAVILION, 2ND FLOOR, PHILADELPHIA, PA 19104-4306
(215) 615-4949
(215) 615-0829
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
MD422739
PA
207RC0000X
Cardiovascular Disease Physician
MT049529
PA
Other
Enumeration date
12/13/2006
Last updated
05/14/2012
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