Provider Demographics
NPI:1376819474
Name:BOLIKAL, PRIYA DURGADAS (MD)
Entity Type:Individual
Prefix:MS
First Name:PRIYA
Middle Name:DURGADAS
Last Name:BOLIKAL
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 1:3333 BURNET AVE.
Mailing Address - Street 2:ML 4009
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3026
Mailing Address - Country:US
Mailing Address - Phone:513-636-7480
Mailing Address - Fax:513-636-7360
Practice Address - Street 1:3333 BURNET AVE.
Practice Address - Street 2:ML 4009
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229
Practice Address - Country:US
Practice Address - Phone:513-636-7480
Practice Address - Fax:513-636-7360
Is Sole Proprietor?:No
Enumeration Date:2012-03-23
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.1335712081P0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation Medicine