Healthcare Provider Details

I. General information

NPI: 1164548020
Provider Name (Legal Business Name): MARK G BOLES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 ROESSLER RD
PITTSBURGH PA
15220-1004
US

IV. Provider business mailing address

100 ROESSLER RD
PITTSBURGH PA
15220-1004
US

V. Phone/Fax

Practice location:
  • Phone: 412-656-3555
  • Fax: 412-981-9558
Mailing address:
  • Phone: 412-656-3555
  • Fax: 412-981-9558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD041044L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: