Praveen Bolarum, MD LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

PRAVEEN BOLARUM, MD LLC

Practice address

3390 Urbana Pike
Frederick, MD 21704-7769

Phone

(301) 810-5415

NPI assigned

Nov 19, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Praveen K Bolarum, MD

Title

Provider

Phone

(301) 694-6688

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Praveen Bolarum MD LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Praveen Bolarum, MD LLC

  • Internal Medicine Physician
  • Clarksburg, MD
  • NPI 1780165738
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1542585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1544054400000",
    "number": "1104395243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3390 URBANA PIKE",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217047769",
            "telephone_number": "301-694-6688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3390 URBANA PIKE",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217047769",
            "telephone_number": "301-810-5415"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "196 Thomas Johnson Dr Ste 135",
            "address_purpose": "LOCATION",
            "city": "Frederick",
            "state": "MD",
            "postal_code": "217024518",
            "country_code": "US",
            "telephone_number": "301-694-6688",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PRAVEEN BOLARUM, MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-19",
        "last_updated": "2018-12-06",
        "status": "A",
        "authorized_official_last_name": "BOLARUM",
        "authorized_official_first_name": "PRAVEEN",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "301-694-6688",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "408672400",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Prafull K Dave MD PA
• Jessica Prall, MA, CCC-SLP
• Elizabeth Claire Prather
• Brian Pratt, LCSW-C
• Kari Pratt, A.R.N.P.
• Praveen Bolarum, MD LLC
• Precision Home Care LLC
• Premier Integrative Health and Wellness
• Premier Orthopedics, P.a.
• Premier Primary Care LLC

• Family Medicine Physician in Frederick, MD
• Providers in Frederick, MD by specialty
• Family Medicine Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.