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General NPI Number Information
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NPI Number | 1336490663
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Entity Type | Organization
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Legal Business Name | BHUPINDER SINGH BOLLA MD PLLC
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Dates
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Enumeration Date | 09/26/2012
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Last Update Date | 01/16/2020
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Provider Practice Location Address
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Address Line | 107 COURT ST
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City | WATERTOWN
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State | NY
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Zip | 13601-2534
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Country | US
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Telephone | 315-782-7246
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Fax |
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Provider Business Mailing Address
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Address Line | 26561 STATE ROUTE 3 STE A
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City | WATERTOWN
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State | NY
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Zip | 13601-1749
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Country | US
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Telephone | 315-782-7246
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. BHUPINDER S BOLLA
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Credential | M.D.
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Telephone | 315-782-7246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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