Provider Demographics
NPI:1992971246
Name:DINO R BONI JR MD PC
Entity type:Organization
Organization Name:DINO R BONI JR MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:MR
Authorized Official - First Name:DINO
Authorized Official - Middle Name:R
Authorized Official - Last Name:BONI
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:724-345-3745
Mailing Address - Street 1:1953 BRUSH RUN RD
Mailing Address - Street 2:
Mailing Address - City:AVELLA
Mailing Address - State:PA
Mailing Address - Zip Code:15312-2004
Mailing Address - Country:US
Mailing Address - Phone:724-345-3745
Mailing Address - Fax:
Practice Address - Street 1:2000 EOFF ST
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-3823
Practice Address - Country:US
Practice Address - Phone:304-233-9314
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3002778000Medicaid
WV3002778000Medicaid
WVDL4037521Medicare PIN