Provider Demographics
NPI:1033323050
Name:BOLING, KATHRYN ALICE (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:ALICE
Last Name:BOLING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:BOLING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:1734 YORK RD DEPT OF
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-5606
Mailing Address - Country:US
Mailing Address - Phone:410-252-2273
Mailing Address - Fax:410-561-3275
Practice Address - Street 1:1734 YORK RD DEPT OF
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-5606
Practice Address - Country:US
Practice Address - Phone:410-252-2273
Practice Address - Fax:410-561-3275
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0077978207Q00000X
CA425983363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily