MEDICARE: DR. JUDITH D BODNAR M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	0101268415	VA

General Provider Information

NPI Number	:	1669464616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUDITH D BODNAR M.D.

Provider Business Mailing Address
First Line	:	3012 LYNNDALE RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-6218
Country	:	US
Telephone Number	:	518-441-4145
Fax Number	:	757-321-3330

Provider Business Practice Location Address
First Line	:	1800 CAMELOT DR STE 300
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-2440
Country	:	US
Telephone Number	:	757-321-3300
Fax Number	:	757-321-3330

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	11/12/2025

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