Provider Demographics
NPI:1023462975
Name:BODMER, DANIEL (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:BODMER
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 1:615 E 14TH ST
Mailing Address - Street 2:APT 7C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-3210
Mailing Address - Country:US
Mailing Address - Phone:443-602-4273
Mailing Address - Fax:
Practice Address - Street 1:615 E 14TH ST
Practice Address - Street 2:APT 7C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-3210
Practice Address - Country:US
Practice Address - Phone:443-602-4273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-18
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00966462085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology