Individual
DR. THOMAS G BOLDUC
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11 HAYDENBERRY DR UNIT 103, MILTON, VT 05468-2200
(802) 893-1200
Mailing address
66 KNIGHT LN STE 10, WILLISTON, VT 05495-9308
(802) 872-4343
(802) 288-1144
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
0420012746
VT
208000000X
Pediatrics Physician
MD00042058
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0420012746
MEDICAL LICENSE
VT
05
—
1022471
—
VT
01
—
172210
L&I
WA
05
—
299829
—
OR
05
—
8364523
—
WA
01
—
P00018622
RAIL ROAD MEDICARE
WA
Enumeration date
02/14/2006
Last updated
03/22/2021
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