Provider Demographics
NPI:1619965969
Name:BODNEY, STEPHEN ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:ANTHONY
Last Name:BODNEY
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:PO BOX 38
Mailing Address - Street 2:
Mailing Address - City:CORYDON
Mailing Address - State:IN
Mailing Address - Zip Code:47112-0038
Mailing Address - Country:US
Mailing Address - Phone:812-738-7830
Mailing Address - Fax:812-738-7833
Practice Address - Street 1:1263 HOSPITAL DR NW STE 270
Practice Address - Street 2:
Practice Address - City:CORYDON
Practice Address - State:IN
Practice Address - Zip Code:47112-2178
Practice Address - Country:US
Practice Address - Phone:812-738-4251
Practice Address - Fax:812-738-7833
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01035411A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200197780Medicaid
IN000000066301OtherANTHEM
G84508Medicare UPIN
IN200197780Medicaid
IN940190EEEMedicare PIN