Provider Demographics
NPI:1366651416
Name:BODZIN, ADAM SETH (MD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:SETH
Last Name:BODZIN
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 1:1100 WALNUT ST FL 5
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4944
Mailing Address - Country:US
Mailing Address - Phone:215-955-4888
Mailing Address - Fax:215-923-7957
Practice Address - Street 1:1100 WALNUT ST FL 5
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4944
Practice Address - Country:US
Practice Address - Phone:215-955-4888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA125543204F00000X
IL336099908204F00000X
PAMD440817208600000X, 204F00000X
PAMT190678208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHI580ZMedicare PIN