Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | D0023013 | MD |
NPI | 1265563001 |
---|---|
Provider Name | Dr. Sacared Bodison |
First Address | Silver Spring, MD 20914-4708 |
Second Address | College Park, MD 20742 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2007 |
Last Update Date | 08/07/2007 |