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NPI Code Detail

MEDICARE: DR. MARK ALAN BOLES M.D.

MEDICARE: DR. MARK ALAN BOLES M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology Physician9700867NC

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1300085676OTHERNCRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
21049UOTHERNCBLUE CROSS BLUE SHIELD
324726OTHERNCPARTNERS
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
570567OTHERNCMEDCOST
61603211OTHERNCUNITED HEALTHCARE

General Provider Information

NPI Number : 1235129388
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARK ALAN BOLES M.D.
Provider Business Mailing Address
First Line : PO BOX 63112
Second Line :
City : CHARLOTTE
State : NC
Zip : 28263-3112
Country : US
Telephone Number : 336-274-9617
Fax Number : 336-482-2177
Provider Business Practice Location Address
First Line : 1331 NORTH ELM STREET
Second Line : SUITE 200
City : GREENSBORO
State : NC
Zip : 27401-6304
Country : US
Telephone Number : 336-274-9617
Fax Number : 336-482-2177
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/28/2005
Last Update Date : 03/10/2023

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Directions to “ DR. MARK ALAN BOLES M.D.” Practice Location

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