Provider Demographics
NPI:1093196826
Name:BOLLINGER, MARLANA SHERIDAN (MD)
Entity Type:Individual
Prefix:
First Name:MARLANA
Middle Name:SHERIDAN
Last Name:BOLLINGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARLANA
Other - Middle Name:RENEE
Other - Last Name:SHERIDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:311 N 4TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21550-1371
Mailing Address - Country:US
Mailing Address - Phone:301-334-7855
Mailing Address - Fax:
Practice Address - Street 1:311 N 4TH ST STE 1
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550
Practice Address - Country:US
Practice Address - Phone:301-334-7855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-17
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0085218207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty