Healthcare Provider Details

I. General information

NPI: 1326076852
Provider Name (Legal Business Name): CARL J. BOLAND M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 SEYMOUR STREET HARTFORD HOSPITAL NEUROLOGY DEPT
HARTFORD CT
06102
US

IV. Provider business mailing address

PO BOX 40,000 DEPT 634 HARTFORD HOSPITAL PROFESSIONAL SERVICES
HARTFORD CT
06151-0634
US

V. Phone/Fax

Practice location:
  • Phone: 860-545-3621
  • Fax:
Mailing address:
  • Phone: 860-545-7602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License Number032883
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: