Provider Demographics
NPI:1316908346
Name:BONDELL, STEVEN P (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:P
Last Name:BONDELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:315 BOULEVARD NE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-1200
Mailing Address - Country:US
Mailing Address - Phone:404-522-0414
Mailing Address - Fax:404-521-9254
Practice Address - Street 1:303 PARKWAY DR NE
Practice Address - Street 2:PATHOLOGY DEPT
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:33120
Practice Address - Country:US
Practice Address - Phone:404-522-0414
Practice Address - Fax:404-521-9254
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA017675207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00569434BMedicaid
B31436Medicare UPIN
GA00569434BMedicaid
GA22BDCKFMedicare PIN