Provider Demographics
NPI:1902921992
Name:BOLTIN, MEGAN S (MD)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:S
Last Name:BOLTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:MEGAN
Other - Middle Name:DUPREE
Other - Last Name:SHULER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2214 OLD CHEROKEE RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-9725
Mailing Address - Country:US
Mailing Address - Phone:803-520-9380
Mailing Address - Fax:803-520-5972
Practice Address - Street 1:1223 S LAKE DR STE G
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29073-6889
Practice Address - Country:US
Practice Address - Phone:803-520-9370
Practice Address - Fax:803-520-9371
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL 29052208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC400685Medicaid
SC3549Medicaid
SCAA3797Medicare UPIN
SC7399Medicare PIN