Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | MD456164 | PA |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | MD456164 | PA |
NPI | 1215370119 |
---|---|
Provider Name | Nicholas Adam Bonazza |
First Address | Grove City, PA 16127-1708 |
Second Address | Grove City, PA 16127-1708 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2013 |
Last Update Date | 29/09/2020 |