MEDICARE: INTERNAL MEDICINE OF ROANOKE PC

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

General Provider Information

NPI Number	:	1831141597
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERNAL MEDICINE OF ROANOKE PC

Provider Business Mailing Address
First Line	:	1315 2ND ST SW
Second Line	:	SUITE 202
City	:	ROANOKE
State	:	VA
Zip	:	24016-4935
Country	:	US
Telephone Number	:	540-344-3020
Fax Number	:	540-344-4394

Provider Business Practice Location Address
First Line	:	1315 2ND ST SW
Second Line	:	SUITE 202
City	:	ROANOKE
State	:	VA
Zip	:	24016-4935
Country	:	US
Telephone Number	:	540-344-3020
Fax Number	:	540-344-4394

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BRIAN SCOTT BOLINGER
Credential	:	M.D.
Telephone Number	:	540-344-3020

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	06/30/2011

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