Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 047797 | MA |
NPI | 1063462018 |
---|---|
Provider Name | Gary C Bolgar |
First Address | Dorchester Center, MA 02124-5628 |
Second Address | Dorchester Center, MA 02124-5628 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2096501 | (05) | MA |
A66487 | (02) |