Wayne Russsell Bonlie, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

D0062606 Issued in MD

Practice address

30 E Padonia Rd
Suite 305
Timonium, MD 21093-2345

Phone

(410) 560-7404

Fax

(443) 588-1725

NPI assigned

Apr 20, 2006

Last updated

Jan 26, 2016By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Previously, effective Oct 1, 2020 through Oct 1, 2026

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Wayne R. Bonlie, M.D., P.a

  • Primary Care Clinic/Center
  • Timonium, MD
  • NPI 1881052454
  Authorized official Same address or phone
• Ez Primed LLC

  • Internal Medicine Physician
  • Timonium, MD
  • NPI 1619614724
  NPD (past)
• Frederick Health Hospital Inc

  dba Frederick Health Hospital

  • General Acute Care Hospital
  • Frederick, MD
  • NPI 1538165527
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1145491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1453766400000",
    "number": "1093770042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 E PADONIA RD",
            "address_2": "SUITE 305",
            "city": "TIMONIUM",
            "state": "MD",
            "postal_code": "210932345",
            "telephone_number": "410-560-7404",
            "fax_number": "443-588-1725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 E PADONIA RD",
            "address_2": "SUITE 305",
            "city": "TIMONIUM",
            "state": "MD",
            "postal_code": "210932345",
            "telephone_number": "410-560-7404",
            "fax_number": "443-588-1725"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONLIE",
        "first_name": "WAYNE",
        "middle_name": "RUSSSELL",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-20",
        "last_updated": "2016-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MD",
            "license": "D0062606",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sheldon Arnold Bloom, D.D.S.
• Neil Howard Blumberg, M.D.
• Bmore Psychotherapy Group, LLC
• Sheila Rolanda Gamboa Bolanos, NP-C, FNP-BC
• Katie Elizabeth Boltz
• Stephen David Bonwit, PTA,RN
• Austin Joseph Schumann Bowden, DDS
• Tracy Austin Bowden, D.D.S.
• Benjamin Bowman
• Mark Aleksander Boyland, DPT

• Family Medicine Physician in Timonium, MD
• Providers in Timonium, MD by specialty
• Family Medicine Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.