| Doctor Name: | MARIE SUSAN BONAVOGLIA |
| NPI Number: | 1245540731 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | MA052473 |
| Business Practice Address: | 1500 Main St Dickson City, PA - 184471343 |
| Business Phone Number: | 5704898940 |
| Business Fax Number: | 5704893445 |
| Mailing Address: | 228 February Dr, SCRANTON |
| State: | PA |
| Postal Code: | 185054356 |
| Phone Number: | 5703442097 |
| Fax Number: | |
| NPI Enumeration Date: | 10/18/2010 |
| NPI Last Update Date: | 01/31/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | MA052473 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |