Provider Demographics
NPI:1356348775
Name:BOLANDER, CARRIE L (DO)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:L
Last Name:BOLANDER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 E CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-5736
Mailing Address - Country:US
Mailing Address - Phone:207-626-1561
Mailing Address - Fax:207-626-1849
Practice Address - Street 1:15 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-5736
Practice Address - Country:US
Practice Address - Phone:207-626-1561
Practice Address - Fax:207-626-1849
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2015-08-18
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
ME1472207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1356348775Medicaid
ME321430099Medicaid
MEG06918Medicare UPIN
MENX3110Medicare PIN