Provider Demographics
NPI:1205885076
Name:BODARY, A KIRK (MD)
Entity type:Individual
Prefix:DR
First Name:A
Middle Name:KIRK
Last Name:BODARY
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 2001
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-4501
Mailing Address - Country:US
Mailing Address - Phone:315-449-0513
Mailing Address - Fax:
Practice Address - Street 1:1065 SENATOR KEATING BLVD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2600
Practice Address - Country:US
Practice Address - Phone:585-256-1330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY177508207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01134418Medicaid
A17485Medicare UPIN
NY01134418Medicaid