Provider Demographics
NPI:1629053640
Name:BOLTON, SARA M (MD)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:M
Last Name:BOLTON
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Gender:F
Credentials:MD
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Mailing Address - Street 1:91 MAIN ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-2599
Mailing Address - Country:US
Mailing Address - Phone:978-369-1924
Mailing Address - Fax:978-369-1924
Practice Address - Street 1:91 MAIN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2599
Practice Address - Country:US
Practice Address - Phone:978-369-1924
Practice Address - Fax:967-369-1924
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2011-05-16
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Provider Licenses
StateLicense IDTaxonomies
MA788182084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ14762Medicare PIN