Provider Demographics
NPI:1225041726
Name:BOLAND, BRIAN JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:JOHN
Last Name:BOLAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1625 N GEORGE MASON DRIVE
Mailing Address - Street 2:SUITE 434
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205
Mailing Address - Country:US
Mailing Address - Phone:703-522-1860
Mailing Address - Fax:703-522-7293
Practice Address - Street 1:1625 N GEORGE MASON DRIVE
Practice Address - Street 2:SUITE 434
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205
Practice Address - Country:US
Practice Address - Phone:703-522-1860
Practice Address - Fax:703-522-7293
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101028005207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5851106Medicaid
B94693Medicare UPIN
VA5851106Medicaid