Provider Demographics
NPI: | 1790896223 |
---|---|
Name: | BOLDING, WILLIAM ROBERT (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | WILLIAM |
Middle Name: | ROBERT |
Last Name: | BOLDING |
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: | 3100 SPRING FOREST RD 130 |
Mailing Address - Street 2: | |
Mailing Address - City: | RALEIGH |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 27616-2880 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 919-882-0706 |
Mailing Address - Fax: | 919-873-9821 |
Practice Address - Street 1: | 3000 NEW BERN AVE |
Practice Address - Street 2: | |
Practice Address - City: | RALEIGH |
Practice Address - State: | NC |
Practice Address - Zip Code: | 27610-1231 |
Practice Address - Country: | US |
Practice Address - Phone: | 919-350-5645 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-08-31 |
Last Update Date: | 2015-11-30 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NC | 28132 | 207L00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NC | 132CN | Other | BCBS NC |
NC | 050055617 | Other | RAILROAD-MEDICARE |
NC | 70174 | Other | PARTNERS |
NC | 4642918 | Other | CIGNA |
NC | 66102 | Other | MEDCOST |
NC | 89132CN | Medicaid | |
NC | 89132CN | Medicaid | |
NC | 132CN | Other | BCBS NC |