Provider Demographics
NPI:1790660538
Name:BOLDEN, MARQUES CAZMERE
Entity type:Individual
Prefix:
First Name:MARQUES
Middle Name:CAZMERE
Last Name:BOLDEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1076 WEYBRIDGE RD # ATPD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2730
Mailing Address - Country:US
Mailing Address - Phone:216-394-7402
Mailing Address - Fax:
Practice Address - Street 1:1076 WEYBRIDGE RD # ATPD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2730
Practice Address - Country:US
Practice Address - Phone:216-394-7402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide