Provider Demographics
NPI:1902025042
Name:BOLES, JEREMIAH CHAD (MD)
Entity Type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:CHAD
Last Name:BOLES
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 1:2901 BLUE RIDGE RD STE 203
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6423
Mailing Address - Country:US
Mailing Address - Phone:919-784-6818
Mailing Address - Fax:919-784-6828
Practice Address - Street 1:2901 BLUE RIDGE RD STE 203
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6423
Practice Address - Country:US
Practice Address - Phone:919-784-6818
Practice Address - Fax:919-784-6828
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200800536207R00000X, 207RH0003X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program