Provider Demographics
NPI:1588681191
Name:BODOR, MARKO V (MD)
Entity type:Individual
Prefix:DR
First Name:MARKO
Middle Name:V
Last Name:BODOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3010 BEARD RD
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-3442
Mailing Address - Country:US
Mailing Address - Phone:707-255-8825
Mailing Address - Fax:707-252-9325
Practice Address - Street 1:3421 VILLA LN
Practice Address - Street 2:SUITE 2B
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-6402
Practice Address - Country:US
Practice Address - Phone:707-255-5454
Practice Address - Fax:707-255-5411
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG63297208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G632970Medicaid
E09099Medicare UPIN
CA00G632970Medicaid