Individual
DR. MARISSA ELIZABETH BONYUN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD, MED, FRCSC
Contact information
Practice address
22 S GREENE ST, BALTIMORE, MD 21201-1544
(410) 328-6280
Mailing address
PO BOX 636256, CINCINNATI, OH 45263-6256
(513) 585-6200
(513) 245-3672
Taxonomy
Speciality
Code
Description
License number
State
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
Primary
35.139373
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
104120
CPSO
—
Enumeration date
07/23/2019
Last updated
08/19/2020
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