Provider Demographics
NPI:1215908660
Name:BONACCI, CATHLEEN (MD)
Entity type:Individual
Prefix:
First Name:CATHLEEN
Middle Name:
Last Name:BONACCI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:585-597 MERRIMACK ST
Mailing Address - Street 2:LOWELL COMMUNITY HEALTH CENTER
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01854
Mailing Address - Country:US
Mailing Address - Phone:978-937-9700
Mailing Address - Fax:978-446-9830
Practice Address - Street 1:597 MERRIMACK ST
Practice Address - Street 2:LOWELL COMMUNITY HEALTH CENTER
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854
Practice Address - Country:US
Practice Address - Phone:978-937-9700
Practice Address - Fax:978-446-9830
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA211266208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
3355263OtherAETNA
9686103OtherCIGNA
975842OtherNETWORK HEALTH
468576OtherTUFTS
AA2914OtherHARVARD PILGRIM HEALTHCAR
57684OtherFALLON
042881348OtherONE HEALTH
MA1305557Medicaid
042881348OtherBEECH STREET
042881348OtherUNICARE
0027404OtherNEIGHBORHOOD HEALTH PLAN
042881348OtherCHOICECARE
J26603OtherBLUE CROSS BLUE SHIELD
MA1305557Medicaid
3355263OtherAETNA