Provider Demographics
NPI:1235129388
Name:BOLES, MARK ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALAN
Last Name:BOLES
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 63112
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28263-3112
Mailing Address - Country:US
Mailing Address - Phone:336-274-9617
Mailing Address - Fax:336-482-2177
Practice Address - Street 1:1331 NORTH ELM STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-6304
Practice Address - Country:US
Practice Address - Phone:336-274-9617
Practice Address - Fax:336-482-2177
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-28
Last Update Date:2023-03-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC97008672085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC300085676OtherRAILROAD MEDICARE
NC1049UOtherBLUE CROSS BLUE SHIELD
NC24726OtherPARTNERS
NC891049UMedicaid
NC70567OtherMEDCOST
NC1603211OtherUNITED HEALTHCARE
NC891049UMedicaid
NC300085676OtherRAILROAD MEDICARE