Provider Demographics
NPI:1659444800
Name:BONAM, SRI RANGA (MD)
Entity type:Individual
Prefix:
First Name:SRI RANGA
Middle Name:
Last Name:BONAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1 MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-3516
Mailing Address - Country:US
Mailing Address - Phone:845-362-5600
Mailing Address - Fax:845-362-5616
Practice Address - Street 1:1 MEDICAL PARK DRIVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970
Practice Address - Country:US
Practice Address - Phone:845-362-5600
Practice Address - Fax:845-362-5616
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2013-12-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY251825207RN0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine