1912909581 NPI number — MS. MARY ELIZABETH BOLTON DPM

Table of content: OLGA MAKARON M.D. (NPI 1538476031)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912909581 NPI number — MS. MARY ELIZABETH BOLTON DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOLTON
Provider First Name:
MARY
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912909581
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/01/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 S MAIN ST
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
CHAGRIN FALLS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44022-3225
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-893-8800
Provider Business Mailing Address Fax Number:
440-893-9422

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 S MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
CHAGRIN FALLS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44022-3225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-893-8800
Provider Business Practice Location Address Fax Number:
440-893-9422
Provider Enumeration Date:
08/12/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  36 002693 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1218328 . This is a "CHA HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 611341106 . This is a "UNITED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 611341106 . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 611341106 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 611341106 . This is a "BLUEGRASS HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000050343 . This is a "ANTHEM" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 480032480 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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