Provider Demographics
NPI:1427176478
Name:BOLDUC, SARAH JANE (MD)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:JANE
Last Name:BOLDUC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:89 GENESEE ST
Mailing Address - Street 2:BK BLDG., 3RD FLOOR
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14611-3201
Mailing Address - Country:US
Mailing Address - Phone:585-368-3031
Mailing Address - Fax:585-368-3037
Practice Address - Street 1:89 GENESEE ST
Practice Address - Street 2:BK BLDG., 3RD FLOOR
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14611-3201
Practice Address - Country:US
Practice Address - Phone:585-368-3031
Practice Address - Fax:585-368-3037
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2017-05-19
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Provider Licenses
StateLicense IDTaxonomies
NY254539207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03357137Medicaid
NYJ400050844/GP BA0017Medicare PIN
NY03357137Medicaid