| Praveen Bolarum, Md Llc | |
|
23310 Frederick Rd Clarksburg MD 20871-9704 | |
| (561) 283-1606 | |
| Not Available |
| Full Name | Praveen Bolarum, Md Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 23310 Frederick Rd, Clarksburg, Maryland |
| Authorized Official Name and Position | Praveen K Bolarum (MD) |
| Authorized Official Contact | 3016946688 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Praveen Bolarum, Md Llc 196 Thomas Johnson Dr Ste 135 Frederick MD 21702-4518 Ph: (561) 283-1606 | Praveen Bolarum, Md Llc 23310 Frederick Rd Clarksburg MD 20871-9704 Ph: (561) 283-1606 |
| NPI Number | 1780165738 |
|---|---|
| Provider Enumeration Date | 08/28/2018 |
| Last Update Date | 09/21/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780165738 | NPI | - | NPPES |
| 590012300 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
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