Basic Information
| Provider Information | |||||||||
| NPI: | 1487652038 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BONTEMPO | ||||||||
| FirstName: | CARL | ||||||||
| MiddleName: | P | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 37174 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212973174 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7036988525 | ||||||||
| FaxNumber: | 7038491918 | ||||||||
| Practice Location | |||||||||
| Address1: | 3300 GALLOWS RD | ||||||||
| Address2: | |||||||||
| City: | FALLS CHURCH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220423307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7037764001 | ||||||||
| FaxNumber: | 7037767113 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2005 | ||||||||
| LastUpdateDate: | 10/04/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 0101020737 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 486335 | 01 | AETNA HMO | OTHER | 541042964 | 01 | HEALTHNET/TRICARE/CHAMPUS | OTHER | 060005779 | 01 | MEDICARE RAILROAD | OTHER | 541042964 | 01 | CIGNA PPO | OTHER | 502853 | 01 | NCPPO | OTHER | 6975-0002 | 01 | CAREFIRST BC/BS | OTHER | 006060986 | 05 | VA | MEDICAID | 4091345 | 01 | AETNA PPO | OTHER | 011551 | 01 | ANTHEM/TRIGON BCBS | OTHER | 22447 | 01 | MAMSI/ALLIANCE | OTHER | 541042964 | 01 | KAISER | OTHER | 541042964 | 01 | PHCS | OTHER |