Healthcare Provider Details

I. General information

NPI: 1245980929
Provider Name (Legal Business Name): EVELYN BODENSCHATZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2022
Last Update Date: 06/28/2025
Certification Date: 06/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 LEE ST
CHARLOTTESVILLE VA
22908-0816
US

IV. Provider business mailing address

40 E MCMICKEN AVE
CINCINNATI OH
45202-6625
US

V. Phone/Fax

Practice location:
  • Phone: 434-924-5348
  • Fax:
Mailing address:
  • Phone: 513-961-0600
  • Fax: 434-924-8335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.153698
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: