Organization
PRAVEEN BOLARUM, MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PRAVEEN K BOLARUM MD (PROVIDER)
(301) 694-6688
Entity
Organization
Contact information
Practice address
3390 URBANA PIKE, FREDERICK, MD 21704-7769
(301) 810-5415
Mailing address
3390 URBANA PIKE, FREDERICK, MD 21704-7769
(301) 694-6688
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
408672400
—
MD
Enumeration date
11/19/2018
Last updated
12/06/2018
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