Provider Demographics
NPI:1861685364
Name:EDWARD J. BUJOLD MD
Entity Type:Organization
Organization Name:EDWARD J. BUJOLD MD
Other - Org Name:GRANITE FALLS FAMILY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOWRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-396-3283
Mailing Address - Street 1:4132 HICKORY BLVD
Mailing Address - Street 2:PO BOX 965
Mailing Address - City:GRANITE FALLS
Mailing Address - State:NC
Mailing Address - Zip Code:28630-8371
Mailing Address - Country:US
Mailing Address - Phone:828-396-3168
Mailing Address - Fax:828-396-8783
Practice Address - Street 1:4132 HICKORY BLVD
Practice Address - Street 2:
Practice Address - City:GRANITE FALLS
Practice Address - State:NC
Practice Address - Zip Code:28630-8371
Practice Address - Country:US
Practice Address - Phone:828-396-3168
Practice Address - Fax:828-396-8783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29829207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC19642OtherBC
NC8919642Medicaid