Healthcare Provider Details

I. General information

NPI: 1841497732
Provider Name (Legal Business Name): KAREN CAMILLE BODNAR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAREN C THIBAULT MD

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 GALLOWS RD
FALLS CHURCH VA
22042
US

IV. Provider business mailing address

PO BOX 37174
BALTIMORE MD
21297-3174
US

V. Phone/Fax

Practice location:
  • Phone: 703-776-6545
  • Fax: 703-776-4323
Mailing address:
  • Phone: 571-423-5699
  • Fax: 571-423-5698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101258684
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101258684
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: