Provider Demographics
NPI:1548237993
Name:BOLIN, DELMAS J (MD)
Entity Type:Individual
Prefix:
First Name:DELMAS
Middle Name:J
Last Name:BOLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8310
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-0310
Mailing Address - Country:US
Mailing Address - Phone:540-345-3556
Mailing Address - Fax:540-342-2193
Practice Address - Street 1:25 W CALHOUN ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-3836
Practice Address - Country:US
Practice Address - Phone:540-772-1890
Practice Address - Fax:540-772-1893
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101233203207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010054427Medicaid
VAH12973Medicare UPIN
VA004660P45Medicare ID - Type UnspecifiedPROVIDER ID