Provider Demographics
NPI:1699085423
Name:BUONOME, ERIN
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:BUONOME
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 JEWETT ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-2548
Mailing Address - Country:US
Mailing Address - Phone:860-874-2446
Mailing Address - Fax:
Practice Address - Street 1:1115 WEST CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301
Practice Address - Country:US
Practice Address - Phone:508-580-4691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTXGS0009860173OtherANTHEM BLUE CROSS BLUE SHIELD
CT966295689OtherUNITED HEALTHCARE