Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD429408 | PA |
Y | 2080P0204X | Pediatric Emergency Doctor | MD429408 | PA |
NPI | 1275759524 |
---|---|
Provider Name | Dr. Christopher Peter Bonafide |
First Address | Philadelphia, PA 19107-3323 |
Second Address | Philadelphia, PA 19104-4319 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2007 |
Last Update Date | 16/04/2013 |