Provider Demographics
NPI:1225157118
Name:BOLT, LINDA LEIGH (PA-C)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:LEIGH
Last Name:BOLT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 WILLIAM HOWARD TAFT RD
Mailing Address - Street 2:2ND FL, CBO2-3, ATTN: CREDENTIALING
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2610
Mailing Address - Country:US
Mailing Address - Phone:513-263-8571
Mailing Address - Fax:513-366-4480
Practice Address - Street 1:2123 AUBURN AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2906
Practice Address - Country:US
Practice Address - Phone:513-721-7373
Practice Address - Fax:513-977-4253
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50-002525363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP10000899676OtherBUCKEYE
OH9670571OtherAETNA
OH790384OtherANTHEM
OH0083895OtherMEDICAID
OH270577733085OtherCARESOURCE
OHH140240OtherMEDICARE
OH1629602OtherGATEWAY HEALTH
OHP01238519OtherRAILROAD MEDICARE