Active NPI
Raleigh J Boulware, MD
- Radiation Oncology Physician
- Columbia, SC
National Provider Identifier
1063493591
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Radiation Oncology Physician
- License
- 8500
- Practice address
- 7 Medical Park
Suite 104
Columbia, SC 29223 - Phone
- (803) 434-3400
- Fax
- (803) 434-3938
- NPI assigned
- Nov 10, 2005
- Last updated
- Oct 4, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Radiation Oncology Physician | 2085R0001X | 8500 | SC | Primary |
Addresses
Primary practice location
7 Medical Park
Suite 104
Columbia, SC 29223
Mailing address
PO Box 2046
West Columbia, SC 29171-2046
Phone (803) 461-3000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 085008 | Medicaid | SC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8500 | SC | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1131580800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1317686400000",
"number": "1063493591",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2046",
"city": "WEST COLUMBIA",
"state": "SC",
"postal_code": "291712046",
"telephone_number": "803-461-3000",
"fax_number": "803-461-4914"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7 MEDICAL PARK",
"address_2": "SUITE 104",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "29223",
"telephone_number": "803-434-3400",
"fax_number": "803-434-3938"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOULWARE",
"first_name": "RALEIGH",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-10",
"last_updated": "2011-10-04",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0001X",
"taxonomy_group": "",
"desc": "Radiology, Radiation Oncology",
"state": "SC",
"license": "8500",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "085008",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Columbia, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.