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General NPI Number Information
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NPI Number | 1669002697
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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 | 01/17/2020
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Last Update Date | 01/20/2020
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Provider Practice Location 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 | 315-782-7247
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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 | 315-782-7247
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | BHUPINDER S BOLLA
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Credential |
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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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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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