Individual
CAROL ANN BOLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
Mailing address
PO BOX 344, WINSTON SALEM, NC 27102-0344
(336) 716-2255
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
97-00481
NC
2085R0202X
Diagnostic Radiology Physician
Primary
97-00481
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10574
BCBS
—
01
—
20062
PARTNERS
—
05
—
220770000
—
WV
01
—
5751457
AETNA
—
05
—
7215576
—
VA
01
—
73370
MEDCOST
—
05
—
8910574
—
NC
05
—
Q00483
—
SC
Enumeration date
01/05/2006
Last updated
10/08/2010
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