Healthcare Provider Details

I. General information

NPI: 1235329368
Provider Name (Legal Business Name): PRASAD V BODAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 11/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PERKINS SQ
AKRON OH
44308-1063
US

IV. Provider business mailing address

1 PERKINS SQ
AKRON OH
44308-1063
US

V. Phone/Fax

Practice location:
  • Phone: 330-543-8730
  • Fax: 330-543-3220
Mailing address:
  • Phone: 330-543-8730
  • Fax: 330-543-3220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.091837
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: