Provider Demographics
NPI:1871607416
Name:BONAUTO, STEVEN J (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:J
Last Name:BONAUTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2 REGENCY PLZ
Mailing Address - Street 2:SUITE 4
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-3160
Mailing Address - Country:US
Mailing Address - Phone:401-351-0236
Mailing Address - Fax:401-351-5005
Practice Address - Street 1:2 REGENCY PLZ
Practice Address - Street 2:SUITE 4
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-3160
Practice Address - Country:US
Practice Address - Phone:401-351-0236
Practice Address - Fax:401-351-5005
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD086292084P0800X
MA787472084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIE68000Medicare UPIN