Provider Demographics
NPI:1063459360
Name:KOLTER, JAMES SAMUEL (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:SAMUEL
Last Name:KOLTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 S. BRYN MAWR AVE
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010
Mailing Address - Country:US
Mailing Address - Phone:484-337-4715
Mailing Address - Fax:484-337-4579
Practice Address - Street 1:130 S BRYN MAWR AVE
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3121
Practice Address - Country:US
Practice Address - Phone:484-337-4715
Practice Address - Fax:484-337-4579
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2017-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD020359E207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B40075Medicare UPIN
PA154008TGWMedicare ID - Type Unspecified
B40075Medicare UPIN
PA0026047000OtherKEYSTONE HEALTH PLAN EAST
PA1652888OtherHIGHMARK BLUE SHIELD