MEDICARE: JEREMIAH CHAD BOLES 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	200800536	NC
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207RH0003X	Hematology & Oncology Physician	200800536	NC

General Provider Information

NPI Number	:	1902025042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMIAH CHAD BOLES M.D.

Provider Business Mailing Address
First Line	:	2901 BLUE RIDGE RD STE 203
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27607-6423
Country	:	US
Telephone Number	:	919-784-6818
Fax Number	:	919-784-6828

Provider Business Practice Location Address
First Line	:	2901 BLUE RIDGE RD STE 203
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27607-6423
Country	:	US
Telephone Number	:	919-784-6818
Fax Number	:	919-784-6828

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

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	08/25/2022

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