MEDICARE: DR. BARRETT HENRY BOLTON 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	207R00000X	Internal Medicine Physician	35-022469	OH

General Provider Information

NPI Number	:	1316378003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BARRETT HENRY BOLTON M.D.

Provider Business Mailing Address
First Line	:	1608 CATALPA DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45406-5946
Country	:	US
Telephone Number	:	937-275-6327
Fax Number	:

Provider Business Practice Location Address
First Line	:	1608 CATALPA DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45406-5946
Country	:	US
Telephone Number	:	937-275-6327
Fax Number	:

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

Provider Enumeration Date	:	12/05/2013
Last Update Date	:	12/05/2013

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