Basic Information
| Provider Information | |||||||||
| NPI: | 1043201510 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOLMAN | ||||||||
| FirstName: | RALPH | ||||||||
| MiddleName: | MORTON | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | III | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 COLCHESTER AVE. | ||||||||
| Address2: | UVM MEDICAL CENTER - CT SURGERY | ||||||||
| City: | BURLINGTON | ||||||||
| State: | VT | ||||||||
| PostalCode: | 05401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8028474044 | ||||||||
| FaxNumber: | 8028478158 | ||||||||
| Practice Location | |||||||||
| Address1: | 111 COLCHESTER AVE. | ||||||||
| Address2: | UVM MEDICAL CENTER - CT SURGERY | ||||||||
| City: | BURLINGTON | ||||||||
| State: | VT | ||||||||
| PostalCode: | 05401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8028474044 | ||||||||
| FaxNumber: | 8028478158 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2005 | ||||||||
| LastUpdateDate: | 06/25/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 224180 | MA | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 042.0013180 | VT | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.