Healthcare Provider Details

I. General information

NPI: 1023433943
Provider Name (Legal Business Name): CLAUDIA BOHDAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2014
Last Update Date: 02/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 S 4TH ST
LEBANON PA
17042-6111
US

IV. Provider business mailing address

1428 POCONO BLVD
MOUNT POCONO PA
18344-1679
US

V. Phone/Fax

Practice location:
  • Phone: 717-270-7500
  • Fax:
Mailing address:
  • Phone: 570-994-2439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA056704
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: