Healthcare Provider Details

I. General information

NPI: 1568427201
Provider Name (Legal Business Name): DAVID J BODOSKY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 E STATE ST
ALBION PA
16401-1306
US

IV. Provider business mailing address

1 LECOM PL
ERIE PA
16505-2571
US

V. Phone/Fax

Practice location:
  • Phone: 814-756-3434
  • Fax: 814-756-4725
Mailing address:
  • Phone:
  • Fax: 814-868-2522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS011001L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: