| Doctor Name: | MR. DAVID THAYER BOLESH |
| NPI Number: | 1093851305 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | RN |
| License Number: | 273579-1 |
| Business Practice Address: | 700 24th St Fort Lee, VA - 238011716 |
| Business Phone Number: | 8047349028 |
| Business Fax Number: | 8047349383 |
| Mailing Address: | 13521 Greyfield Dr, CHESTER |
| State: | VA |
| Postal Code: | 238316769 |
| Phone Number: | 8047349028 |
| Fax Number: | 8047349383 |
| NPI Enumeration Date: | 01/30/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WI0600X |
| License Number: | 273579-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Infection Control |
| Taxonomy Definition: | |