Provider Demographics
NPI:1134135338
Name:HOLLOWELL, JEAN G (MD)
Entity Type:Individual
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First Name:JEAN
Middle Name:G
Last Name:HOLLOWELL
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Gender:F
Credentials:MD
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Mailing Address - Street 1:711 TROY SCHENECTADY RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2442
Mailing Address - Country:US
Mailing Address - Phone:518-213-0478
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:23 HACKETT BLVD
Practice Address - Street 2:MC 208
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3436
Practice Address - Country:US
Practice Address - Phone:518-262-3341
Practice Address - Fax:518-262-6660
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2010-04-12
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Provider Licenses
StateLicense IDTaxonomies
NY175342-12088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2125582OtherALLIANCE/MDIPA
VA010066379Medicaid
VA2125582OtherMAMSI/OPTIMUM CHOICE
VA4239662OtherAETNA
VA138022OtherANTHEM BCBS
VA3116108340006EOtherCIGNA
VA76601OtherOPTIMA/SENTARA HEALTH
NY01095692Medicaid
VA311610834OtherNC HEALTH CHOICE
VA790668JOtherNORTH CAROLINA MEDICAID
VA2125582OtherMAMSI/OPTIMUM CHOICE
VA4239662OtherAETNA
NY01095692Medicaid