Provider Demographics
NPI:1912915786
Name:BONIDIE, MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:BONIDIE
Suffix:
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 1:2025 TECHNOLOGY PKWY STE 108
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-9401
Mailing Address - Country:US
Mailing Address - Phone:717-791-2590
Mailing Address - Fax:717-221-5466
Practice Address - Street 1:2025 TECHNOLOGY PKWY STE 108
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-9401
Practice Address - Country:US
Practice Address - Phone:717-791-2590
Practice Address - Fax:717-221-5466
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD064975L207VF0040X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyUrogynecology and Reconstructive Pelvic Surgery
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA160059091OtherRAILROAD MEDICARE
PA0017015390004Medicaid
PA160059091OtherRAILROAD MEDICARE
PA0017015390004Medicaid