Provider Demographics
NPI:1699761288
Name:BONNER, HUGH III (MD)
Entity type:Individual
Prefix:
First Name:HUGH
Middle Name:
Last Name:BONNER
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 N CLAYTON ST
Mailing Address - Street 2:2ND FLOOR, MEDICAL SERVICES BUILDING
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-3165
Mailing Address - Country:US
Mailing Address - Phone:302-575-8040
Mailing Address - Fax:302-575-8005
Practice Address - Street 1:701 N CLAYTON ST
Practice Address - Street 2:2ND FLOOR MEDICAL SERVICE BUILDING
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-3165
Practice Address - Country:US
Practice Address - Phone:302-575-8040
Practice Address - Fax:302-575-8005
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0004738207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEP00367200OtherRAILROAD MEDICARE INDIV
DE000725401Medicaid
DE000725401Medicaid
G25071Medicare UPIN