Provider Demographics
NPI:1316935034
Name:BOOLBOL, ROBERT J (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:BOOLBOL
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Gender:M
Credentials:MD
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Mailing Address - Street 1:11350 MCCORMICK RD
Mailing Address - Street 2:EXECUTIVE PLAZA 1, SUITE 501
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21031
Mailing Address - Country:US
Mailing Address - Phone:410-329-1071
Mailing Address - Fax:410-329-1054
Practice Address - Street 1:11 SOUTH RD
Practice Address - Street 2:SUITE 250
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032
Practice Address - Country:US
Practice Address - Phone:860-674-0222
Practice Address - Fax:860-674-0024
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2018-06-26
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Provider Licenses
StateLicense IDTaxonomies
CT040205174400000X, 207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No174400000XOther Service ProvidersSpecialist
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F63803Medicare UPIN
CT720000002Medicare ID - Type Unspecified