Provider Demographics
NPI:1376655795
Name:BOLAND, EDWARD H (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:H
Last Name:BOLAND
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Gender:M
Credentials:MD
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Mailing Address - Street 1:3830 WASHINGTON RD
Mailing Address - Street 2:SUITE 17
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-5064
Mailing Address - Country:US
Mailing Address - Phone:706-922-0440
Mailing Address - Fax:706-922-0441
Practice Address - Street 1:3830 WASHINGTON RD
Practice Address - Street 2:SUITE 17
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-5064
Practice Address - Country:US
Practice Address - Phone:706-922-0440
Practice Address - Fax:706-922-0441
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-02-12
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Provider Licenses
StateLicense IDTaxonomies
GA040826207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H57250Medicare UPIN