Matthew J Bonanno, MD

Primary specialty

Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X

License

ME88794 Issued in FL

Practice address

1295 Jacaranda Blvd
Venice, FL 34292-4522

Phone

(941) 484-1510

Fax

(941) 484-1071

NPI assigned

Sep 14, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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

• Howard D. Solomon, DO, PC

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  • Forest Hills, NY
  • NPI 1598054520
  NPD (past)

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

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1464739200000",
    "number": "1679678338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15051 S TAMIAMI TRL",
            "address_2": "SUITE 203",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339085182",
            "telephone_number": "239-437-8810",
            "fax_number": "239-313-2555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1295 JACARANDA BLVD",
            "city": "VENICE",
            "state": "FL",
            "postal_code": "342924522",
            "telephone_number": "941-484-1510",
            "fax_number": "941-484-1071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONANNO",
        "first_name": "MATTHEW",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-14",
        "last_updated": "2016-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "FL",
            "license": "ME88794",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FL MEDICAL LICENSE",
            "identifier": "ME88794",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Socheatra P Bokach, P.A.C
• Gary Eugene Bolen, DC
• Cameron Jennay Boles, LMHC
• Robert Bolton, DDS MS
• Jennifer Michelle Bomalaski
• Kirsten Bond
• Lisa Camille Bonin, PA-C
• Jeremy Bonjorno, D.P.M.
• Chandana Bopitiya, M.D.
• Samantha Hope Bouie, APRN

• Plastic and Reconstructive Surgery Physician in Venice, FL
• Providers in Venice, FL by specialty
• Plastic and Reconstructive Surgery Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.