Jeffrey P Bolduan, M.D.

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

01030767 Issued in IN

Practice address

1808 Charlton CT
Goshen, IN 46526-6463

Phone

(574) 533-8420

Fax

(574) 533-3909

NPI assigned

Nov 6, 2006

Last updated

Dec 23, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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.

• Jeffrey P. Bolduan, M.D. Inc

  • Urology Physician
  • Goshen, IN
  • NPI 1538320577
  Authorized official Same address or phone
• Goshen Health System Inc

  • Family Medicine Physician
  • Goshen, IN
  • NPI 1194772293
  NPD
• Goshen Health System Inc

  dba Goshen Physicians Diagnostics

  • Radiology Clinic/Center
  • Goshen, IN
  • NPI 1588190284
  NPD

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

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734912000000",
    "number": "1831278027",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1808 CHARLTON CT",
            "city": "GOSHEN",
            "state": "IN",
            "postal_code": "465266463",
            "telephone_number": "574-533-8420",
            "fax_number": "574-533-3909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1808 CHARLTON CT",
            "city": "GOSHEN",
            "state": "IN",
            "postal_code": "465266463",
            "telephone_number": "574-533-8420",
            "fax_number": "574-533-3909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLDUAN",
        "first_name": "JEFFREY",
        "middle_name": "P",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-06",
        "last_updated": "2024-12-23",
        "certification_date": "2024-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "IN",
            "license": "01030767",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jeffrey.bolduan@goshenhealthdirect.com",
            "affiliation": "N",
            "endpointDescription": "Effective 5/15/23",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "1615 Winsted Dr Ste 4",
            "city": "Goshen",
            "state": "IN",
            "country_code": "US",
            "postal_code": "465264673",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Stephanie Biscette, MSW
• Elizabeth Ruth Lapp Black, MSW, LSW
• Carrie J Bloss, OTR
• Kathryn Bobson
• Alyssa Bogunia, RBT
• Boling Vision Center, LLC
• Oluwakemi Gbemisola Bond
• Amy Bontrager, LMHC
• Cynthia Bontrager, MD
• Serenity Bontrager

• Urology Physician in Goshen, IN
• Providers in Goshen, IN by specialty
• Urology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2024; 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.