Provider Demographics
NPI:1316983745
Name:BOLLING, THOMAS VANCE (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:VANCE
Last Name:BOLLING
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:330 NC HIGHWAY 108
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORDTON
Mailing Address - State:NC
Mailing Address - Zip Code:28139
Mailing Address - Country:US
Mailing Address - Phone:828-286-1743
Mailing Address - Fax:828-287-3731
Practice Address - Street 1:330 NC HIGHWAY 108
Practice Address - Street 2:
Practice Address - City:RUTHERFORDTON
Practice Address - State:NC
Practice Address - Zip Code:28139
Practice Address - Country:US
Practice Address - Phone:828-286-1743
Practice Address - Fax:828-287-3731
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2019-04-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ND8239208600000X
SC9980208600000X
NC23469208600000X
TN25768208600000X
AK4403208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ024752Medicaid
VA1316983745Medicaid
NC1229FOtherBCBS
TN3001288Medicaid
SC340156Medicaid
NC8916467Medicaid
NC1962821322Medicaid
NC8916467Medicaid
NCC81100Medicare UPIN
VA1316983745Medicaid