Provider Demographics
NPI:1548572704
Name:BOLLAVARAM, NAGABHUSHANAM R (MD)
Entity Type:Individual
Prefix:
First Name:NAGABHUSHANAM
Middle Name:R
Last Name:BOLLAVARAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-0936
Mailing Address - Country:US
Mailing Address - Phone:606-330-7840
Mailing Address - Fax:606-330-7825
Practice Address - Street 1:1401 HARRODSBURG RD STE A300
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3787
Practice Address - Country:US
Practice Address - Phone:859-313-4744
Practice Address - Fax:859-276-5939
Is Sole Proprietor?:No
Enumeration Date:2010-07-05
Last Update Date:2019-05-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY45813207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease