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General NPI Number Information
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NPI Number | 1184713661
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Entity Type | Individual
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Provider Name | BARRY PAUL BODEN MD
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Gender | Male
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 02/19/2024
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Provider Practice Location Address
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Address Line | 14995 SHADY GROVE RD STE 350
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City | ROCKVILLE
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State | MD
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Zip | 20850-8726
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Country | US
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Telephone | 301-251-1433
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Fax | 301-424-5266
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Provider Business Mailing Address
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Address Line | PO BOX 79831
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City | BALTIMORE
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State | MD
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Zip | 21279-0831
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Country | US
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Telephone | 301-251-1433
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Fax | 301-424-5266
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | D0050899
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | D0050899
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License Number State | MD
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