Provider Demographics
NPI:1588624456
Name:BOLTON, EILEEN CAROL (MD)
Entity Type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:CAROL
Last Name:BOLTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:890 HIGH STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-4193
Mailing Address - Country:US
Mailing Address - Phone:614-540-7339
Mailing Address - Fax:614-540-7338
Practice Address - Street 1:890 HIGH STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-4193
Practice Address - Country:US
Practice Address - Phone:614-540-7339
Practice Address - Fax:614-540-7338
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2018-09-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35.060139208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0804937Medicaid