Provider Demographics
NPI:1053360032
Name:BOLON, CLAIRE E (MD)
Entity type:Individual
Prefix:DR
First Name:CLAIRE
Middle Name:E
Last Name:BOLON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 WESTGATE LANE
Mailing Address - Street 2:
Mailing Address - City:WEST NEWBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05085-9207
Mailing Address - Country:US
Mailing Address - Phone:802-345-2679
Mailing Address - Fax:
Practice Address - Street 1:290 WESTGATE LANE
Practice Address - Street 2:
Practice Address - City:WEST NEWBURY
Practice Address - State:VT
Practice Address - Zip Code:05085
Practice Address - Country:US
Practice Address - Phone:802-345-2679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420010361208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT30200393Medicaid
NHORE5372Medicaid
NHRE5372Medicare PIN
VT30200393Medicaid