Provider Demographics
NPI:1801906219
Name:BOLER, LYNN EILEEN (MD)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:EILEEN
Last Name:BOLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LYNN
Other - Middle Name:E
Other - Last Name:FRATERRIGO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:700 MCCLELLAN ST
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12304-1019
Mailing Address - Country:US
Mailing Address - Phone:518-382-1130
Mailing Address - Fax:518-382-1173
Practice Address - Street 1:700 MCCLELLAN ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12304-1019
Practice Address - Country:US
Practice Address - Phone:518-382-1130
Practice Address - Fax:518-382-1173
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237581207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI44672Medicare UPIN
NYRA8463Medicare ID - Type Unspecified