Basic Information
Provider Information | |||||||||
NPI: | 1669408035 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BOBONICH | ||||||||
FirstName: | ARLENE | ||||||||
MiddleName: | SKURKIS | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 100 NORTH ACADEMY AVE. | ||||||||
Address2: |   | ||||||||
City: | DANVILLE | ||||||||
State: | PA | ||||||||
PostalCode: | 178224903 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5702716144 | ||||||||
FaxNumber: | 5702716578 | ||||||||
Practice Location | |||||||||
Address1: | 503 NORTH 21ST ST. | ||||||||
Address2: |   | ||||||||
City: | CAMP HILL | ||||||||
State: | PA | ||||||||
PostalCode: | 171108531 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7177632100 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/25/2006 | ||||||||
LastUpdateDate: | 08/25/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 08/25/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD056474L | PA | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207RH0002X | 18307 | NV | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Hospice and Palliative Medicine | 207RH0002X | MD056474L | PA | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Hospice and Palliative Medicine |
ID Information
ID | Type | State | Issuer | Description | 5106062 | 01 | PA | AETNA | OTHER | 001536177 | 05 | PA |   | MEDICAID | 17866 | 01 | PA | GEISINGER | OTHER | 545561 | 01 | MP | CAREFIRST MD BCBS | OTHER | 0813919000 | 01 | PA | AMERIHEALTH 65 PA | OTHER | 104599 | 01 | PA | JOHNS HOPKINS | OTHER | 788245 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER |