Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0000X | Hematologist | G60001 | CA |
NPI | 1407897143 |
---|---|
Provider Name | Dr. Charles Daniel Bolan JR. |
First Address | Potomac, MD 20854-2217 |
Second Address | Bethesda, MD 20892-1475 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2006 |
Last Update Date | 26/02/2013 |