Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 0101019805 | VA |
NPI | 1003943226 |
---|---|
Provider Name | Warren K. Bolton |
First Address | Charlottesville, VA 22903-2981 |
Second Address | Charlottesville, VA 22908-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B10320 | (02) | VA |