Provider Demographics
NPI:1841799939
Name:BODIN, SEAN R (PA)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:R
Last Name:BODIN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6415 HOT SPRING LN
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-2576
Mailing Address - Country:US
Mailing Address - Phone:540-940-3224
Mailing Address - Fax:
Practice Address - Street 1:125 OLDE GREENWICH DR STE 300
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-4008
Practice Address - Country:US
Practice Address - Phone:540-374-5599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-05
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110006081363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical