Individual
DR. BRIAN ERIC BOLDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1000 E MOUNTAIN BLVD, WILKES BARRE, PA 18711-0027
(570) 808-7399
(570) 808-5942
Mailing address
100 N ACADEMY AVE, DANVILLE, PA 17822-4903
(570) 214-5681
(570) 271-6578
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD423426
PA
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
Primary
MD423426
PA
208M00000X
Hospitalist Physician
MD423426
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001582999
HIGHMARK BS
PA
05
—
100000222 0003 0004
—
PA
01
—
1007307260034
MEDICAID GROUP #
PA
05
—
1010002220001
—
PA
01
—
867633
MEDICARE GROUP #
PA
Enumeration date
03/24/2006
Last updated
07/29/2020
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