Provider Demographics
NPI:1619175494
Name:HOWARD BOLTANSKY MD PC
Entity Type:Organization
Organization Name:HOWARD BOLTANSKY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLTANSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-966-7100
Mailing Address - Street 1:3301 NEW MEXICO AVENUE NW
Mailing Address - Street 2:SUITE 223
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016
Mailing Address - Country:US
Mailing Address - Phone:202-966-7100
Mailing Address - Fax:202-966-2196
Practice Address - Street 1:3301 NEW MEXICO AVENUE NW
Practice Address - Street 2:SUITE 223
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016
Practice Address - Country:US
Practice Address - Phone:202-966-7100
Practice Address - Fax:202-966-7100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD14490207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E23602Medicare UPIN
DCG00818Medicare PIN