Provider Demographics
NPI:1467486118
Name:BODOR, STEPHANIE M (MD)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:M
Last Name:BODOR
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 1:77 W. MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:HOPKINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01748
Mailing Address - Country:US
Mailing Address - Phone:508-435-5506
Mailing Address - Fax:508-497-5079
Practice Address - Street 1:77 W. MAIN ST.
Practice Address - Street 2:
Practice Address - City:HOPKINTON
Practice Address - State:MA
Practice Address - Zip Code:01748
Practice Address - Country:US
Practice Address - Phone:508-435-5506
Practice Address - Fax:508-497-5079
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA212971208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ24759OtherBLUE CROSS/BLUE SHIELD
MA2942274OtherAETNA/US HEALTHCARE
MA2942274OtherAETNA
MA204597OtherHARVARD PILGRIM
MA461234OtherTUFTS
MA0192970Medicaid
MA198177OtherHEALTHSOURCE(CMHC)
MA6079812001OtherCIGNA
MA2942274OtherAETNA