Individual
DR. TRACI M BOLOGNA-JILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
1 RANDALL SQ STE 408, PROVIDENCE, RI 02904-7405
(401) 453-2000
(401) 253-2002
Mailing address
1 RANDALL SQ STE 408, PROVIDENCE, RI 02904-7405
(401) 453-2000
(401) 253-2002
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
DPM00367
RI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/02/2018
Last updated
12/15/2022
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