Individual provider Active NPI

John A Bodine, MD

  • Diagnostic Radiology Physician
  • Baltimore, MD
National Provider Identifier
1700822673
Registry record updated Jun 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
D0028720 Issued in MD
Practice address
7253 Ambassador Rd
Baltimore, MD 21244-2710
Phone
(443) 436-1151
Fax
(443) 436-1256
NPI assigned
Jun 21, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X D0028720 MD Primary
Vascular & Interventional Radiology Physician 2085R0204X D0028720 MD

Addresses

Primary practice location

7253 Ambassador Rd
Baltimore, MD 21244-2710

Mailing address

7253 Ambassador Rd
Baltimore, MD 21244-2710
Phone (443) 436-1151

Other identifiers 1

IdentifierTypeStateIssuer
369291400MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1213920000000",
    "number": "1700822673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7253 AMBASSADOR RD",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212442710",
            "telephone_number": "443-436-1151",
            "fax_number": "443-436-1256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7253 AMBASSADOR RD",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212442710",
            "telephone_number": "443-436-1151",
            "fax_number": "443-436-1256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BODINE",
        "first_name": "JOHN",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-21",
        "last_updated": "2008-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MD",
            "license": "D0028720",
            "primary": true
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "MD",
            "license": "D0028720",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "369291400",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.