Wayne R. Bonlie, M.D., P.a

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

D0062606 Issued in MD

Legal business name

WAYNE R. BONLIE, M.D., P.A

Practice address

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

Phone

(410) 560-7404

Fax

(443) 588-1725

NPI assigned

Feb 10, 2016

Organization subpart

No

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

Authorized official

Name

Wayne Russell Bonlie, MD

Title

President

Phone

(410) 560-7404

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1455062400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1467244800000",
    "number": "1881052454",
    "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": {
        "organization_name": "WAYNE R. BONLIE, M.D., P.A",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-10",
        "last_updated": "2016-06-30",
        "status": "A",
        "authorized_official_last_name": "BONLIE",
        "authorized_official_first_name": "WAYNE",
        "authorized_official_middle_name": "RUSSELL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "410-560-7404",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "MD",
            "license": "D0062606",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Primary Care Clinic/Center in Timonium, MD
• Providers in Timonium, MD by specialty
• Primary Care Clinic/Center in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 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.