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General NPI Number Information
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NPI Number | 1669464616
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Entity Type | Individual
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Provider Name | JUDITH D BODNAR M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/16/2005
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Last Update Date | 11/12/2025
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Provider Practice Location Address
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Address Line | 1800 CAMELOT DR STE 300
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-2440
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Country | US
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Telephone | 757-321-3300
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Fax | 757-321-3330
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Provider Business Mailing Address
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Address Line | 3012 LYNNDALE RD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-6218
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Country | US
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Telephone | 518-441-4145
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Fax | 757-321-3330
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0101268415
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License Number State | VA
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