Individual
AMANDA T BOLBOTOWSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
376 ARSENAL ST, WATERTOWN, MA 02472-2892
(617) 923-2273
Mailing address
43 HARVARD AVE UNIT 1, MEDFORD, MA 02155-3504
(203) 243-7505
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA5788
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA5788
PA LICENSE
MA
Enumeration date
08/15/2016
Last updated
07/21/2022
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