Denise M Bolan, RPA C
Individual provider Active NPI Medical Physician Assistant · Newcomb, NY
NPI 1609946839 · NPPES record last updated Oct 4, 2016
Key facts
- NPI
- 1609946839
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- 002715 (NY)
- Practice address
- 4 Santanoni Dr
Newcomb, NY 12852 - Phone
- (518) 582-2991
- Fax
- (518) 582-2040
- NPI assigned
- Nov 8, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0027151 | NY | MD | Family Medicine Physician |
| 002715 | NY | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Russell E Rider, MD | Family Medicine | Past | Accepting new patients |
Interoperability endpoints
- https://api.platform.athenahealth.com/2469/brand/4/csg/23/fhir/r4
- denise.bolan.1@2469.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 0027151 | NY | |
| Medical Physician Assistant | 363AM0700X | 002715 | NY | Yes |
Addresses
Primary practice location
4 Santanoni Dr
Newcomb, NY 12852
Mailing address
4 Santanoni Dr
Newcomb, NY 12852-1913
Phone (518) 582-2991
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01110874 | Medicaid | NY |
Other providers in Newcomb, NY
- Kevin P Bolan
- Newcomb Central School District
- Newcomb Volunteer Fire Dept.
- Megan Amber Rozell
- Russell E Rider, MD
All providers in Newcomb, NY · Medical Physician Assistant in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 4, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.