Provider Demographics
NPI:1972687093
Name:BODEA-BAROTHI, STELIAN PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:STELIAN
Middle Name:PAUL
Last Name:BODEA-BAROTHI
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 1:11797 SOUTH FWY
Mailing Address - Street 2:SUITE 338
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-7026
Mailing Address - Country:US
Mailing Address - Phone:817-293-3222
Mailing Address - Fax:
Practice Address - Street 1:11797 SOUTH FWY
Practice Address - Street 2:SUITE 338
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-7026
Practice Address - Country:US
Practice Address - Phone:817-293-3222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD338472084P0800X
TXM50622084P0800X, 2084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
H94487Medicare UPIN