Provider Demographics
NPI:1316962988
Name:BONDI, EDWARD E (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:E
Last Name:BONDI
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:3400 CIVIC CENTER BLVD
Mailing Address - Street 2:1-330S PERELMAN CENTER
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-5127
Mailing Address - Country:US
Mailing Address - Phone:215-662-2737
Mailing Address - Fax:215-615-3424
Practice Address - Street 1:3400 CIVIC CENTER BLVD
Practice Address - Street 2:1-330S PERELMAN CENTER
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-5127
Practice Address - Country:US
Practice Address - Phone:215-662-2737
Practice Address - Fax:215-615-3424
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD016953E207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016669120001Medicaid
PA0016669120001Medicaid
PA034333Medicare PIN