Provider Demographics
NPI:1740462548
Name:BODE, DAVID VICTOR (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:VICTOR
Last Name:BODE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5801 ARMY PENTAGON
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20310-5801
Mailing Address - Country:US
Mailing Address - Phone:703-692-8810
Mailing Address - Fax:703-692-6118
Practice Address - Street 1:5801 ARMY PENTAGON
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20310-5801
Practice Address - Country:US
Practice Address - Phone:703-692-8810
Practice Address - Fax:703-692-6118
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-04
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060157207Q00000X, 207QA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD 000Medicare UPIN