Praveen Bolarum, MD LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

PRAVEEN BOLARUM, MD LLC

Practice address

23310 Frederick Rd
Clarksburg, MD 20871-9704

Phone

(561) 283-1606

NPI assigned

Aug 28, 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

Title

MD

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

  • Family Medicine Physician
  • Frederick, MD
  • NPI 1104395243
  NPD tax ID

Locations

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

{
    "created_epoch": "1535414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1537488000000",
    "number": "1780165738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "196 THOMAS JOHNSON DR STE 135",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217024518",
            "telephone_number": "561-283-1606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23310 FREDERICK RD",
            "city": "CLARKSBURG",
            "state": "MD",
            "postal_code": "208719704",
            "telephone_number": "561-283-1606"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "196 Thomas Johnson Dr Ste 135",
            "address_purpose": "LOCATION",
            "city": "Frederick",
            "state": "MD",
            "postal_code": "217024518",
            "country_code": "US",
            "telephone_number": "561-283-1606",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PRAVEEN BOLARUM, MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-28",
        "last_updated": "2018-09-21",
        "status": "A",
        "authorized_official_last_name": "BOLARUM",
        "authorized_official_first_name": "PRAVEEN",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "301-694-6688"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "590012300",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Clarksburg, MD
• Providers in Clarksburg, MD by specialty
• Internal Medicine Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 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.