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General NPI Number Information
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NPI Number | 1194729111
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Entity Type | Individual
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Provider Name | DONNA MARIE BOLDEN MD
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Gender | Female
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Dates
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Enumeration Date | 06/08/2005
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Last Update Date | 04/08/2025
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Provider Practice Location Address
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Address Line | 10777 COUNTY ROAD 107
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City | PROCTORVILLE
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State | OH
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Zip | 45669-8130
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Country | US
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Telephone | 740-302-0541
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Fax |
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Provider Business Mailing Address
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Address Line | 305 N 5TH ST
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City | IRONTON
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State | OH
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Zip | 45638-1578
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Country | US
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Telephone | 740-532-4858
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 38597
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License Number State | KY
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