Thomas G Bolduc, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

0420012746 Issued in VT

Practice address

11 Haydenberry Dr Unit 103
Milton, VT 05468-2200

Phone

(802) 893-1200

NPI assigned

Feb 14, 2006

Last updated

Mar 22, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 6

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Primary Care Health Partners

  • Pediatrics Physician
  • S Burlington, VT
  • NPI 1295792745
  NPD
• Primary Care Health Partners - New York LLP

  • Family Medicine Physician
  • Plattsburgh, NY
  • NPI 1003861782

  Pediatrics

  NPD (past)

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

{
    "created_epoch": "1139875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616371200000",
    "number": "1487628608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "66 KNIGHT LN STE 10",
            "city": "WILLISTON",
            "state": "VT",
            "postal_code": "054959308",
            "telephone_number": "802-872-4343",
            "fax_number": "802-288-1144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 HAYDENBERRY DR UNIT 103",
            "city": "MILTON",
            "state": "VT",
            "postal_code": "054682200",
            "telephone_number": "802-893-1200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "51 Timber Ln",
            "address_purpose": "LOCATION",
            "city": "South Burlington",
            "state": "VT",
            "postal_code": "054035201",
            "country_code": "US",
            "telephone_number": "802-864-0521",
            "fax_number": "802-864-6475",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOLDUC",
        "first_name": "THOMAS",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-14",
        "last_updated": "2021-03-22",
        "certification_date": "2021-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WA",
            "license": "MD00042058",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "VT",
            "license": "0420012746",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "P00018622",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1022471",
            "state": "VT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "299829",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I",
            "identifier": "172210",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8364523",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "0420012746",
            "state": "VT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "drbolduc@pchpmd.medentdirect.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "11 Haydenberry Dr Unit 103",
            "city": "Milton",
            "state": "VT",
            "country_code": "US",
            "postal_code": "054682200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kim Barber
• Michael Bergman
• Raphael Bielinski, M.D
• Blooming Wisdom Psychiatry, PLLC
• Kristin Boerman, PT
• Katherine J Bradley, PT
• Hannah Cole Brown
• Andrea J Bushey, ATC
• Emily Carvey, LISCW, LADC
• Heidi Lee Cary, M.S.

• Pediatrics Physician in Milton, VT
• Providers in Milton, VT by specialty
• Pediatrics Physician in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2021; 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.