Provider Demographics
NPI:1952329310
Name:BODEA, MARIOARA CISMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIOARA
Middle Name:CISMAS
Last Name:BODEA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 N ELAM AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403-1100
Mailing Address - Country:US
Mailing Address - Phone:336-852-8444
Mailing Address - Fax:336-852-8401
Practice Address - Street 1:522 N ELAM AVE STE 203
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-1100
Practice Address - Country:US
Practice Address - Phone:336-852-8444
Practice Address - Fax:336-852-8401
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200600552208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
2300597OtherUNITED HEALTHCARE
802215OtherPARTNERS
198454OtherMEDCOST
P00626383OtherMEDICARE RAILROAD
143ECOtherBCBS
7617550OtherAETNA
6245177OtherCIGNA
NC89133E6Medicaid
P00626383OtherMEDICARE RAILROAD
198454OtherMEDCOST
2053022AMedicare PIN