Provider Demographics
NPI:1356329882
Name:BOLGIANO, EDWARD B (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:B
Last Name:BOLGIANO
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 1:1908 BROADWAY RD
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-1403
Mailing Address - Country:US
Mailing Address - Phone:410-561-0341
Mailing Address - Fax:
Practice Address - Street 1:2000 W BALTIMORE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21223-1558
Practice Address - Country:US
Practice Address - Phone:410-362-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0031993174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB68602Medicare UPIN