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NPI Code Detail

MEDICARE: MRS. DONNA MARIE BOLDEN MD

MEDICARE: MRS. DONNA MARIE BOLDEN MD
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
1208000000XPediatrics Physician38597KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2000000550503OTHERKYANTHEM BCBS
300000328135OTHERKYANTHEM BC/BS
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1194729111
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DONNA MARIE BOLDEN MD
Provider Business Mailing Address
First Line : 305 N 5TH ST
Second Line :
City : IRONTON
State : OH
Zip : 45638-1578
Country : US
Telephone Number : 740-532-4858
Fax Number :
Provider Business Practice Location Address
First Line : 10777 COUNTY ROAD 107
Second Line :
City : PROCTORVILLE
State : OH
Zip : 45669-8130
Country : US
Telephone Number : 740-302-0541
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2005
Last Update Date : 04/08/2025

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Directions to “ MRS. DONNA MARIE BOLDEN MD” Practice Location

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