Individual
MR. TODD S BOLOTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6252 MAHONING AVE, AUSTINTOWN, OH 44515-2003
(330) 792-7418
(330) 792-9092
Mailing address
5700 DARROW RD, SUITE 106, HUDSON, OH 44236-5021
(330) 656-5911
(330) 656-5901
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
35060979B
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000028430
ANTHEM
OH
01
—
000000349348
ANTHEM
OH
01
—
000000381140
ANTHEM
OH
01
—
001522135-0005
PENNSYLVANIA MEDICAID
OH
05
—
0858433
—
OH
Enumeration date
12/13/2005
Last updated
06/11/2008
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