Provider Demographics
NPI:1851475487
Name:BODROGI, ANITA M (DO)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:M
Last Name:BODROGI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 COURT ST
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-2733
Mailing Address - Country:US
Mailing Address - Phone:518-562-2369
Mailing Address - Fax:518-562-2263
Practice Address - Street 1:96 COURT ST
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-2733
Practice Address - Country:US
Practice Address - Phone:518-562-2369
Practice Address - Fax:518-562-2263
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0320000511208D00000X
NY000000230057208D00000X
NY230057207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY800084544OtherBC BS
VT4128833OtherMVP
VT0VN3526Medicaid
VT68536OtherBC BS
NYIA0645Medicare ID - Type Unspecified
VTVN3526Medicare ID - Type Unspecified
VT68536OtherBC BS
VTVN3526Medicare ID - Type Unspecified
VT800084544OtherCBA