Provider Demographics
NPI:1184713661
Name:BODEN, BARRY PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:PAUL
Last Name:BODEN
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:PO BOX 79831
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21279-0831
Mailing Address - Country:US
Mailing Address - Phone:301-251-1433
Mailing Address - Fax:301-424-5266
Practice Address - Street 1:14995 SHADY GROVE RD STE 350
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-8726
Practice Address - Country:US
Practice Address - Phone:301-251-1433
Practice Address - Fax:301-424-5266
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0050899207XX0005X, 207X00000X, 207XX0005X, 207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
347535OtherMDIPA/OPCHOICE
5405091004OtherCIGNA
093557OtherANTHEM
217566133OtherTRICARE
347535OtherALLIANCE/MAMSI
54223602OtherCAREFIRST BLUE CROSS
37520008OtherBLUE CROSS OF NATL CAP AR
G20290Medicare UPIN
008058047Medicare ID - Type Unspecified