# PRAVEEN BOLARUM, MD LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780165738
- **Authorized official:** PRAVEEN K BOLARUM (MD)
- **Authorized official phone:** (301) 694-6688

## Contact information

- **Practice address:** 23310 FREDERICK RD, CLARKSBURG, MD 20871-9704
- **Practice address phone:** (561) 283-1606
- **Mailing address:** 196 THOMAS JOHNSON DR STE 135, FREDERICK, MD 21702-4518
- **Mailing address phone:** (561) 283-1606

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/28/2018
- **Last updated:** 09/21/2018