Healthcare Provider Details

I. General information

NPI: 1275822264
Provider Name (Legal Business Name): ANEEL KUMAR BOLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2011
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 MYRTLE ST STE 190
ERIE PA
16502-4604
US

IV. Provider business mailing address

2315 MYRTLE ST STE 190
ERIE PA
16502-4604
US

V. Phone/Fax

Practice location:
  • Phone: 814-453-7767
  • Fax: 814-454-6667
Mailing address:
  • Phone: 814-453-7767
  • Fax: 814-454-6667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number01074100A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number37122
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberMD443177
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: