Healthcare Provider Details

I. General information

NPI: 1033176706
Provider Name (Legal Business Name): SUDHIR BOLAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 FRIENDSHIP ST
NEWPORT RI
02840-2271
US

IV. Provider business mailing address

10 ORMS ST SUITE 110
PROVIDENCE RI
02904-2228
US

V. Phone/Fax

Practice location:
  • Phone: 401-253-4063
  • Fax:
Mailing address:
  • Phone: 401-453-0666
  • Fax: 401-453-9619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number11461
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: