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General NPI Number Information
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NPI Number | 1659767366
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Entity Type | Individual
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Provider Name | JEFFREY BOLSTRIDGE D.O.
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Gender | Male
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Dates
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Enumeration Date | 04/09/2015
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Last Update Date | 01/30/2025
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Provider Practice Location Address
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Address Line | 8901 WISCONSIN AVE DEPARTMENT OF PEDIATRICS
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City | BETHESDA
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State | MD
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Zip | 20889-4504
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Country | US
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Telephone | 301-319-2391
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Fax |
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Provider Business Mailing Address
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Address Line | 8901 WISCONSIN AVE DEPARTMENT OF PEDIATRICS
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City | BETHESDA
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State | MD
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Zip | 20889-0001
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 102204710
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 2080P0203X
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Taxonomy Name | Pediatric Critical Care Medicine Physician
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License Number | 102204710
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License Number State | VA
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