Provider Demographics
NPI:1912909581
Name:BOLTON, MARY ELIZABETH (DPM)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ELIZABETH
Last Name:BOLTON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 S MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44022-3225
Mailing Address - Country:US
Mailing Address - Phone:440-893-8800
Mailing Address - Fax:440-893-9422
Practice Address - Street 1:1 S MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:CHAGRIN FALLS
Practice Address - State:OH
Practice Address - Zip Code:44022-3225
Practice Address - Country:US
Practice Address - Phone:440-893-8800
Practice Address - Fax:440-893-9422
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36 002693213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1218328OtherCHA HEALTH
611341106OtherUNITED
611341106OtherHUMANA
611341106OtherFIRST HEALTH
611341106OtherBLUEGRASS HEALTH
KY000000050343OtherANTHEM
KY480032480OtherRAILROAD MEDICARE
U17286Medicare UPIN
1218328OtherCHA HEALTH
611341106OtherHUMANA