Provider Demographics
NPI:1407897143
Name:BOLAN, CHARLES DANIEL JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:DANIEL
Last Name:BOLAN
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:9312 BELLS MILL RD
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-2217
Mailing Address - Country:US
Mailing Address - Phone:301-256-8668
Mailing Address - Fax:301-402-1360
Practice Address - Street 1:ROOM 4 5140 MSC 1475 BLDG 10
Practice Address - Street 2:HEMATOLOGY BRANCH, NHLBI, NIH
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20892-1475
Practice Address - Country:US
Practice Address - Phone:301-451-7099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG60001207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology