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1336490663 NPI number — BHUPINDER SINGH BOLLA MD PLLC

NPI Number: 1336490663
Health Care Provider/Practitioner: BHUPINDER SINGH BOLLA MD PLLC

Information about “1336490663” NPI (BHUPINDER SINGH BOLLA MD PLLC) exists in 1336490663 in HTML format HTML  |  1336490663 in plain Text format TXT  |  1336490663 in PDF (Portable Document Format) PDF  |  1336490663 in an XML format XML  formats.

NPI Number : 1336490663 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1336490663",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "BHUPINDER SINGH BOLLA MD PLLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "26561 STATE ROUTE 3 STE A",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WATERTOWN",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "13601-1749",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "315-782-7246",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "107 COURT ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WATERTOWN",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "13601-2534",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "315-782-7246",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/26/2012",
    "LastUpdateDate": "01/16/2020",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "BOLLA",
    "AuthorizedOfficialFirstName": "BHUPINDER",
    "AuthorizedOfficialMiddleName": "S",
    "AuthorizedOfficialTitle": "PRESIDENT/OWNER",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "M.D.",
    "AuthorizedOfficialTelephoneNumber": "315-782-7246",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "208VP0014X",
        "TaxonomyName": "Interventional Pain Medicine Physician",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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