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NPI Code Detail

MEDICARE: KOHLDON CARTER BOYDSTON MD

MEDICARE: KOHLDON CARTER BOYDSTON 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
1208800000XUrology Physician76733WI

General Provider Information

NPI Number : 1518320100
Entity Type Code : Individual
Provider Name (Legal Business Name) : KOHLDON CARTER BOYDSTON MD
Provider Business Mailing Address
First Line : 2301 ERWIN RD
Second Line :
City : DURHAM
State : NC
Zip : 27705-4699
Country : US
Telephone Number : 919-684-8111
Fax Number :
Provider Business Practice Location Address
First Line : 2600 N MAYFAIR RD STE 545
Second Line :
City : WAUWATOSA
State : WI
Zip : 53226-1306
Country : US
Telephone Number : 414-476-0430
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/31/2016
Last Update Date : 09/27/2022

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