Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | MD419757 | PA |
NPI | 1548480585 |
---|---|
Provider Name | Patricia Joan Bonitatibus |
First Address | Wheeling, WV 26003-6042 |
Second Address | Aliquippa, PA 15001-5410 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2007 |
Last Update Date | 08/07/2007 |