Provider Demographics
NPI:1770819856
Name:BOLTON, GINA DARLIN
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:DARLIN
Last Name:BOLTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-7912
Mailing Address - Country:US
Mailing Address - Phone:302-233-8226
Mailing Address - Fax:
Practice Address - Street 1:1003 HIGH ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-7912
Practice Address - Country:US
Practice Address - Phone:302-677-2604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-26
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians