Provider Demographics
NPI:1790755338
Name:BODZINER, RICHARD ALLAN (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALLAN
Last Name:BODZINER
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 1:6602 WATERS AVE
Mailing Address - Street 2:BUILDING C
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-2778
Mailing Address - Country:US
Mailing Address - Phone:912-354-7676
Mailing Address - Fax:
Practice Address - Street 1:6602 WATERS AVE
Practice Address - Street 2:BUILDING C
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2778
Practice Address - Country:US
Practice Address - Phone:912-354-7676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0262242084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000287944EMedicaid
GA13BDDWCMedicare ID - Type Unspecified
GA000287944EMedicaid