Provider Demographics
NPI:1164517702
Name:MARK S. BOLAND D.O., F.A.C.O.S.,P.C.
Entity Type:Organization
Organization Name:MARK S. BOLAND D.O., F.A.C.O.S.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PLASTIC AND RECONSTRUCTIVE SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:BOLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-541-8898
Mailing Address - Street 1:840 SIR THOMAS COURT
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-4839
Mailing Address - Country:US
Mailing Address - Phone:717-541-8898
Mailing Address - Fax:717-541-0641
Practice Address - Street 1:840 SIR THOMAS COURT
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-4839
Practice Address - Country:US
Practice Address - Phone:717-541-8898
Practice Address - Fax:717-541-0641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-005543-L2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1793471OtherHIGHMARK GROUP NUMBER
PA119358Medicare ID - Type Unspecified
PA1793471OtherHIGHMARK GROUP NUMBER
PA119358Medicare ID - Type Unspecified