Provider Demographics
NPI:1407807902
Name:BOLES, MILTON BIZZELLE (MD,DMD)
Entity Type:Individual
Prefix:DR
First Name:MILTON
Middle Name:BIZZELLE
Last Name:BOLES
Suffix:
Gender:M
Credentials:MD,DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 REED ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-4309
Mailing Address - Country:US
Mailing Address - Phone:781-863-2033
Mailing Address - Fax:
Practice Address - Street 1:830 CHALKSTONE AVE.
Practice Address - Street 2:VA MEDICAL CENTER
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-4734
Practice Address - Country:US
Practice Address - Phone:401-457-3056
Practice Address - Fax:401-457-3353
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA77595207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology