Healthcare Provider Details

I. General information

NPI: 1144425422
Provider Name (Legal Business Name): GYORGY BODROG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 11/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

543 NORTH ST SUITE #9
NEW BEDFORD MA
02740-2782
US

IV. Provider business mailing address

57 MIRANDA WAY
BRIDGEWATER MA
02324-1481
US

V. Phone/Fax

Practice location:
  • Phone: 508-984-5566
  • Fax:
Mailing address:
  • Phone: 508-577-0185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number218788
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number218788
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: