Provider Demographics
NPI:1356491724
Name:BODOR-BILLINGS, SUZANNE CHRISTINE (MD)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:CHRISTINE
Last Name:BODOR-BILLINGS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:C
Other - Last Name:BODOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3000 COLBY ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2058
Mailing Address - Country:US
Mailing Address - Phone:510-848-7977
Mailing Address - Fax:510-848-2831
Practice Address - Street 1:3000 COLBY ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2058
Practice Address - Country:US
Practice Address - Phone:510-848-7977
Practice Address - Fax:510-848-2831
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA71432207R00000X
TXH2254207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE72603Medicare UPIN