Organization
COAST TO COAST CALIFORNIA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK JAMES BOLTON MD (OWNER)
(614) 855-9961
Entity
Organization
Contact information
Practice address
5195 HAMPSTED VILLAGE CENTER WAY, SUITE 256, NEW ALBANY, OH 43054-8331
(614) 855-9961
Mailing address
5195 HAMPSTED VILLAGE CENTER WAY, SUITE 256, NEW ALBANY, OH 43054-8331
(614) 855-9961
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
A64578
CA
207Q00000X
Family Medicine Physician
A64578
CA
208D00000X
General Practice Physician
A64578
CA
Other
Enumeration date
08/17/2015
Last updated
08/17/2015
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