Provider Demographics
NPI:1740219740
Name:BOLAND, NEIL CARTER (MD)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:CARTER
Last Name:BOLAND
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 1:2181 SE OCEAN BLVD
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34996-3305
Mailing Address - Country:US
Mailing Address - Phone:772-220-8766
Mailing Address - Fax:772-220-8786
Practice Address - Street 1:2181 SE OCEAN BLVD
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34996-3305
Practice Address - Country:US
Practice Address - Phone:772-220-8766
Practice Address - Fax:772-220-8786
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0037591174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL042807800Medicaid
FLD44883Medicare UPIN