Provider Demographics
NPI:1427120062
Name:BOSHOLM, CAROL CHRISTINE (MD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:CHRISTINE
Last Name:BOSHOLM
Suffix:
Gender:F
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 776
Mailing Address - Street 2:
Mailing Address - City:ETOWAH
Mailing Address - State:NC
Mailing Address - Zip Code:28729-0776
Mailing Address - Country:US
Mailing Address - Phone:828-489-6697
Mailing Address - Fax:
Practice Address - Street 1:5722 W US HIGHWAY 64
Practice Address - Street 2:STE 10
Practice Address - City:MURPHY
Practice Address - State:NC
Practice Address - Zip Code:28906-8120
Practice Address - Country:US
Practice Address - Phone:910-618-0026
Practice Address - Fax:910-618-1746
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9600151207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCBB4010536OtherDEA
NCBB4010536OtherDEA