Provider Demographics
NPI:1861430563
Name:BODONI, ANDRAS A (MD,FCCP)
Entity type:Individual
Prefix:
First Name:ANDRAS
Middle Name:A
Last Name:BODONI
Suffix:
Gender:M
Credentials:MD,FCCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 E 19TH AVE
Mailing Address - Street 2:SUITE 3100
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1239
Mailing Address - Country:US
Mailing Address - Phone:303-863-0300
Mailing Address - Fax:303-863-7014
Practice Address - Street 1:1601 E 19TH AVE
Practice Address - Street 2:SUITE 3100
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1239
Practice Address - Country:US
Practice Address - Phone:303-863-0300
Practice Address - Fax:303-863-7014
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO41156207RC0200X, 207RP1001X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO68723717Medicaid
CO68723717Medicaid
COCO305332Medicare PIN