Provider Demographics
NPI:1750373486
Name:CHEN, BONNIE L (MD)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:L
Last Name:CHEN
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 1:510 ROUTE 6 AND 209
Mailing Address - Street 2:SUITE 8
Mailing Address - City:MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18337-7615
Mailing Address - Country:US
Mailing Address - Phone:570-296-5950
Mailing Address - Fax:570-296-1066
Practice Address - Street 1:510 ROUTE 6 AND 209
Practice Address - Street 2:SUITE 8
Practice Address - City:MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18337-7615
Practice Address - Country:US
Practice Address - Phone:570-296-5950
Practice Address - Fax:570-296-1066
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD422582207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001964066 0001Medicaid
NY2529995Medicaid
PA072482QLQMedicare ID - Type Unspecified
NY145AY2Medicare ID - Type Unspecified
PA001964066 0001Medicaid