Healthcare Provider Details

I. General information

NPI: 1841829546
Provider Name (Legal Business Name): FABIAN JOHANNES BOLTE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2020
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 LEE ST BOX #800716
CHARLOTTESVILLE VA
22908-0816
US

IV. Provider business mailing address

1215 LEE ST BOX #800716
CHARLOTTESVILLE VA
22908-0816
US

V. Phone/Fax

Practice location:
  • Phone: 434-999-8757
  • Fax:
Mailing address:
  • Phone: 434-297-4058
  • Fax: 434-244-7534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number0101289644
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: