Provider Demographics
NPI:1295753911
Name:BODINE, ANDREA MARANGONI (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:MARANGONI
Last Name:BODINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-7463
Mailing Address - Country:US
Mailing Address - Phone:413-442-2226
Mailing Address - Fax:413-442-1314
Practice Address - Street 1:740 WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-7463
Practice Address - Country:US
Practice Address - Phone:413-442-2226
Practice Address - Fax:413-442-1314
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA75787174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA075787OtherTUFT HEALTH PLAN
MA000000024296OtherBMC HEALTH NET PLAN
MA9706437Medicaid
MAM17692OtherBLUE CROSS BLUE SHIELD
MAM17692OtherBLUE CROSS BLUE SHIELD
MA000000024296OtherBMC HEALTH NET PLAN