Basic Information
| Provider Information | |||||||||
| NPI: | 1619973534 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BONAVENTE | ||||||||
| FirstName: | ARNULFO | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10403 HOSPITAL DR | ||||||||
| Address2: | STE G4 | ||||||||
| City: | CLINTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207353137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018563019 | ||||||||
| FaxNumber: | 3018569370 | ||||||||
| Practice Location | |||||||||
| Address1: | 6409 CRAIN HWY | ||||||||
| Address2: | ROUTE 301 | ||||||||
| City: | UPPER MARLBORO | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207724139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3019528614 | ||||||||
| FaxNumber: | 3016271603 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2005 | ||||||||
| LastUpdateDate: | 12/20/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | D0045630 | MD | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.