Provider Demographics
NPI:1255338307
Name:BOLES, SAMUEL FRANK (MD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:FRANK
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:PO BOX 15659
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4051
Mailing Address - Country:US
Mailing Address - Phone:410-224-2010
Mailing Address - Fax:
Practice Address - Street 1:127 LUBRANO DR
Practice Address - Street 2:SUITE 301
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7114
Practice Address - Country:US
Practice Address - Phone:410-224-2010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0051567207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
4612891OtherAETNA PPO
547947108OtherBCBS
MD711502400Medicaid
1479534OtherAETNA HMO
54794109OtherBCBS
0001OtherBCBS
10252068OtherAMERIGROUP
54794110OtherBCBS
54794107OtherBCBS
1479534OtherAETNA HMO
54794107OtherBCBS
453P884GMedicare PIN