MEDICARE: DR. KATHRYN ALICE BOLING 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
1	207Q00000X	Family Medicine Physician	D0077978	MD

General Provider Information

NPI Number	:	1033323050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHRYN ALICE BOLING M.D

Provider Business Mailing Address
First Line	:	1734 YORK RD DEPT OF
Second Line	:
City	:	LUTHERVILLE TIMONIUM
State	:	MD
Zip	:	21093-5606
Country	:	US
Telephone Number	:	410-252-2273
Fax Number	:	410-561-3275

Provider Business Practice Location Address
First Line	:	1734 YORK RD DEPT OF
Second Line	:
City	:	LUTHERVILLE TIMONIUM
State	:	MD
Zip	:	21093-5606
Country	:	US
Telephone Number	:	410-252-2273
Fax Number	:	410-561-3275

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	03/11/2022

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