Provider Demographics
NPI:1346212750
Name:BOLDYS, SUSAN ELAINE (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ELAINE
Last Name:BOLDYS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5650 W CENTRAL AVE STE D
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-1510
Mailing Address - Country:US
Mailing Address - Phone:419-534-2888
Mailing Address - Fax:419-534-2898
Practice Address - Street 1:950 W WOOSTER ST
Practice Address - Street 2:WOOD COUNTY HOSPITAL
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-2603
Practice Address - Country:US
Practice Address - Phone:419-354-8977
Practice Address - Fax:419-373-4157
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35045449B207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0986278Medicaid
MI3403231100Medicaid
OHB00766922Medicare ID - Type Unspecified
OH0986278Medicaid