Provider Demographics
NPI:1174635924
Name:BOLAND, THOMAS S (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:S
Last Name:BOLAND
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2661 RIVA RD STE 1030
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7131
Mailing Address - Country:US
Mailing Address - Phone:410-571-8733
Mailing Address - Fax:410-571-6309
Practice Address - Street 1:200 MIFFLIN AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503
Practice Address - Country:US
Practice Address - Phone:570-342-3145
Practice Address - Fax:570-344-1309
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD050762L207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
808091OtherFIRST PRIORITY HEALTH
BO196826OtherHIGH MARK BLUE SHIELD
506554OtherAETNA
180035485OtherRAILROAD MEDICARE
PA001735395Medicaid
42487OtherGEISINGER HEALTH PLAN
PA022271Medicare ID - Type Unspecified
PA001735395Medicaid