Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Pavan Bolla, MD

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1790670834

Pavan Bolla, MD is an Internal Medicine in Utica, New York. Qualified in 2013, 13 years ago. Licensed in New York.

Years since qualifying
13
Licensed in
NY
In the registry since
2025
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

120 Hobart St
Utica, NY 13501-4308
Phone: (315) 798-1149
Fax: (315) 801-3565
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Student in an Organized Health Care Education/Training Program (primary) Taxonomy 390200000X (NY)

Record details

NPI number1790670834
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedJune 10, 2025
Last updated in NPPESApril 9, 2026
Certification dateApril 9, 2026
Mailing address111 Hospital Dr, Utica, NY 13502-2517

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyINTERNAL MEDICINE
Medical schoolOTHER
Graduated 2013 (13 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

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