Individual
JOHN WILLIAM BOLEN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
200 HOSPITAL DR, GALAX, VA 24333-2227
(703) 236-8175
Mailing address
110 VALLEY ST, GALAX, VA 24333-2224
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
0101040131
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007202865
—
VA
01
—
300038351
RAILROAD MEDICARE
—
Enumeration date
02/06/2006
Last updated
02/20/2014
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