Individual
DR. JASON ANDREW BONOMO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD, PHD
Contact information
Practice address
8081 INNOVATION PARK DR STE 700, FAIRFAX, VA 22031-4867
(571) 472-2900
Mailing address
PO BOX 37174, BALTIMORE, MD 21297-3174
(571) 423-5699
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
0101274803
VA
207RC0000X
Cardiovascular Disease Physician
Primary
0101274803
VA
208M00000X
Hospitalist Physician
036.149207
IL
Other
Enumeration date
06/02/2016
Last updated
10/28/2022
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