Provider Demographics
NPI:1831336007
Name:BOLDUR, CARMIT A (MD)
Entity type:Individual
Prefix:
First Name:CARMIT
Middle Name:A
Last Name:BOLDUR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:901 RANCHO LN
Mailing Address - Street 2:SUITE #175
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-3836
Mailing Address - Country:US
Mailing Address - Phone:702-636-3000
Mailing Address - Fax:702-636-6345
Practice Address - Street 1:901 RANCHO LN
Practice Address - Street 2:SUITE #175
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-3836
Practice Address - Country:US
Practice Address - Phone:702-636-3000
Practice Address - Fax:702-636-6345
Is Sole Proprietor?:No
Enumeration Date:2009-01-09
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY250774-12084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY250774-1OtherNY MEDICAL LICENSE