Organization
PRAVEEN BOLARUM, MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PRAVEEN K BOLARUM (MD)
(301) 694-6688
Entity
Organization
Contact information
Practice address
23310 FREDERICK RD, CLARKSBURG, MD 20871-9704
(561) 283-1606
Mailing address
196 THOMAS JOHNSON DR STE 135, FREDERICK, MD 21702-4518
(561) 283-1606
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
590012300
—
MD
Enumeration date
08/28/2018
Last updated
09/21/2018
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