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General NPI Number Information
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NPI Number | 1790988491
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Entity Type | Organization
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Legal Business Name | ANDREA M. BODINE, M.D., P.C.
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Dates
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Enumeration Date | 06/08/2007
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Last Update Date | 07/11/2007
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Provider Practice Location Address
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Address Line | 740 WILLIAMS ST
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City | PITTSFIELD
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State | MA
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Zip | 01201-7463
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Country | US
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Telephone | 413-442-2226
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Fax | 413-442-1314
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Provider Business Mailing Address
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Address Line | 740 WILLIAMS ST
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City | PITTSFIELD
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State | MA
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Zip | 01201-7463
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Country | US
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Telephone | 413-442-2226
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Fax | 413-442-1314
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANDREA M. BODINE
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Credential | M.D.
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Telephone | 413-442-2226
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 75787
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License Number State | MA
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