Provider Demographics
NPI:1073789954
Name:BOLINGER, CHARLES ARTHUR (CPED)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:ARTHUR
Last Name:BOLINGER
Suffix:
Gender:M
Credentials:CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4546 MAPLECREST RD
Mailing Address - Street 2:
Mailing Address - City:FT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46835
Mailing Address - Country:US
Mailing Address - Phone:260-492-1752
Mailing Address - Fax:260-492-1752
Practice Address - Street 1:4546 MAPLECREST RD
Practice Address - Street 2:
Practice Address - City:FT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46835
Practice Address - Country:US
Practice Address - Phone:260-492-1752
Practice Address - Fax:260-492-1752
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
1954OtherCPED
46966OtherPFA