Provider Demographics
NPI:1629192018
Name:BUONOMO, LUZMARIE (MD)
Entity type:Individual
Prefix:
First Name:LUZMARIE
Middle Name:
Last Name:BUONOMO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 EASTVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-5968
Mailing Address - Country:US
Mailing Address - Phone:561-303-1282
Mailing Address - Fax:
Practice Address - Street 1:815 EASTVIEW AVE
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-5968
Practice Address - Country:US
Practice Address - Phone:561-303-1282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR128592085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH82252Medicare UPIN