Provider Demographics
NPI:1144425422
Name:BODROG, GYORGY (MD)
Entity Type:Individual
Prefix:DR
First Name:GYORGY
Middle Name:
Last Name:BODROG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 MIRANDA WAY
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02324-1481
Mailing Address - Country:US
Mailing Address - Phone:508-577-0185
Mailing Address - Fax:
Practice Address - Street 1:543 NORTH ST
Practice Address - Street 2:SUITE #9
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-2782
Practice Address - Country:US
Practice Address - Phone:508-984-5566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2187882084F0202X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2163101Medicaid
MA000314103Medicare PIN
MA000314103Medicare UPIN