Individual
CAROLYN MIRA BOLTIN
Active
Individual
CAROLYN MIRA BOLTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
221744-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000A961420
BLUE SHIELD OF CA
—
05
—
00A961420
—
CA
01
—
050396C161340
TRAILBLAZER
—
01
—
P00384787
RAILROAD MEDICARE
—
Enumeration date
07/21/2006
Last updated
09/12/2023
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