Provider Demographics
NPI:1992795413
Name:BONTEMPO, DOMINIC J (DO)
Entity type:Individual
Prefix:
First Name:DOMINIC
Middle Name:J
Last Name:BONTEMPO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1 W ELM ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-2007
Mailing Address - Country:US
Mailing Address - Phone:610-567-6967
Mailing Address - Fax:610-567-6170
Practice Address - Street 1:2705 DEKALB PIKE
Practice Address - Street 2:SUITE 309
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-1852
Practice Address - Country:US
Practice Address - Phone:610-277-6131
Practice Address - Fax:610-277-4966
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2010-07-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS004390L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA35760OS004390LOtherHEALTHPARTNERS
PA4309685OtherCIGNA
PA232515999OtherUHC
PA0010439420002Medicaid
PA0104394201OtherAMERICHOICE
PA2406OtherBRAVO/ELDERHEALTH
PA30024862OtherKMHP
PA3985917OtherAETNA USH HMO
PA0045161000OtherIBC
PA232515999024OtherHEALTHNET FEDERAL
PA000465313OtherHIGHMARK BLUE SHIELD
PA4255212OtherAETNA USH PPO
PA465313R64Medicare PIN
PA0010439420002Medicaid
PA35760OS004390LOtherHEALTHPARTNERS