Individual
YAROSLAV DANIEL BODNAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
210 S CAMERON ST, HILLSBOROUGH, NC 27278-2505
(919) 732-9311
Mailing address
5221 PARAMOUNT PKWY STE 220, MORRISVILLE, NC 27560-5490
(984) 215-4111
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
125.070456
IL
207R00000X
Internal Medicine Physician
2024-01939
NC
208000000X
Pediatrics Physician
036155975
IL
208000000X
Pediatrics Physician
125.070456
IL
208000000X
Pediatrics Physician
Primary
2024-01939
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
125.070456
TEMPORARY MEDICAL LICENSE
IL
Enumeration date
06/19/2017
Last updated
11/06/2024
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