Individual
DR. JOANN N BODURTHA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
600 N WOLFE ST, BLALOCK 1012 D MEDICAL GENETICS, BALTIMORE, MD 21287-0005
(410) 955-1699
(410) 614-9246
Mailing address
PO BOX 64316, BALTIMORE, MD 21264-4316
Taxonomy
Speciality
Code
Description
License number
State
207SG0201X
Clinical Genetics (M.D.) Physician
0101036738
VA
207SG0201X
Clinical Genetics (M.D.) Physician
Primary
D73075
MD
208000000X
Pediatrics Physician
0101036738
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
049028800
—
MD
05
—
6756964
—
VA
Enumeration date
10/27/2006
Last updated
12/10/2016
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