Provider Demographics
NPI:1003884388
Name:BOLOTTE, CHARLES P (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:P
Last Name:BOLOTTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 HIGHWAY 402
Mailing Address - Street 2:
Mailing Address - City:NAPOLEONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70390-2217
Mailing Address - Country:US
Mailing Address - Phone:985-369-6027
Mailing Address - Fax:985-447-8556
Practice Address - Street 1:141 HIGHWAY 402
Practice Address - Street 2:
Practice Address - City:NAPOLEONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70390-2217
Practice Address - Country:US
Practice Address - Phone:985-369-6027
Practice Address - Fax:985-447-8556
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA012686207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1160709Medicaid
LAB62608Medicare UPIN
LA1160709Medicaid