Provider Demographics
NPI:1568467009
Name:KROKER-BODE, CLAUDIA A (MD)
Entity Type:Individual
Prefix:MRS
First Name:CLAUDIA
Middle Name:A
Last Name:KROKER-BODE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:CLAUDIA
Other - Middle Name:A
Other - Last Name:KROKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1906 BELLEVIEW AVENUE
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014
Mailing Address - Country:US
Mailing Address - Phone:540-981-7000
Mailing Address - Fax:
Practice Address - Street 1:1906 BELLEVIEW AVENUE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014
Practice Address - Country:US
Practice Address - Phone:540-981-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2013-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD50040207Q00000X, 207R00000X
VA0101252869207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD416300100Medicaid
MD416300100Medicaid
MDG20382Medicare UPIN