Individual
BRADLEY BOLDIZAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
169 ASHLEY AVE, ROOM 202 MAIN HOSPITAL, MSC333, CHARLESTON, SC 29425-8905
(843) 792-1414
Mailing address
169 ASHLEY AVE, ROOM 202 MAIN HOSPITAL, MSC333, CHARLESTON, SC 29425-8905
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
LL32657
SC
Other
Enumeration date
06/18/2010
Last updated
06/18/2010
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