Individual
JULIA T BONACUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
301 SAINT PAUL PL, 11TH FLOOR, BALTIMORE, MD 21202-2102
(410) 332-9573
(410) 238-5598
Mailing address
PO BOX 64075, BALTIMORE, MD 21264-4075
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
D0050236
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
024700600
—
MD
01
—
KX 46 ST / 547804-04
BC / BS OF MD
MD
01
—
S185 / 0001
BLUECHOICE
MD
Enumeration date
06/09/2006
Last updated
06/09/2010
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