| Praveen Bolarum, Md Llc | |
|
3390 Urbana Pike Frederick MD 21704-7769 | |
| (301) 810-5415 | |
| Not Available |
| Full Name | Praveen Bolarum, Md Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 3390 Urbana Pike, Frederick, Maryland |
| Authorized Official Name and Position | Praveen K Bolarum (PROVIDER) |
| Authorized Official Contact | 3016946688 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Praveen Bolarum, Md Llc 3390 Urbana Pike Frederick MD 21704-7769 Ph: (301) 694-6688 | Praveen Bolarum, Md Llc 3390 Urbana Pike Frederick MD 21704-7769 Ph: (301) 810-5415 |
| NPI Number | 1104395243 |
|---|---|
| Provider Enumeration Date | 11/19/2018 |
| Last Update Date | 12/06/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104395243 | NPI | - | NPPES |
| 408672400 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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