Healthcare Provider Details

I. General information

NPI: 1154458867
Provider Name (Legal Business Name): ADAM HAIM BOLDT DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3434 12TH AVE NE
OLYMPIA WA
98506-5175
US

IV. Provider business mailing address

3434 12TH AVE NE
OLYMPIA WA
98506-5175
US

V. Phone/Fax

Practice location:
  • Phone: 360-413-8470
  • Fax: 360-413-8490
Mailing address:
  • Phone: 360-413-8470
  • Fax: 360-413-8490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD037381
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberH0067778
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number063173
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOP60663438
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: