Healthcare Provider Details

I. General information

NPI: 1912983305
Provider Name (Legal Business Name): GINGER BOLES PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 W MAIN ST
BRIDGEPORT WV
26330-1751
US

IV. Provider business mailing address

2301 BLAKE ST STE 100
DENVER CO
80205-2102
US

V. Phone/Fax

Practice location:
  • Phone: 304-842-3137
  • Fax:
Mailing address:
  • Phone: 720-355-0031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number00391
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: