Provider Demographics
NPI:1851325047
Name:MARKO BODOR MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MARKO BODOR MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARKO
Authorized Official - Middle Name:V
Authorized Official - Last Name:BODOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-255-5454
Mailing Address - Street 1:3010 BEARD RD
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-3442
Mailing Address - Country:US
Mailing Address - Phone:707-255-8825
Mailing Address - Fax:707-252-9325
Practice Address - Street 1:3421 VILLA LN
Practice Address - Street 2:SUITE 2B
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-6402
Practice Address - Country:US
Practice Address - Phone:707-255-5454
Practice Address - Fax:707-255-5411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG63297208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ23895ZMedicare ID - Type Unspecified