Provider Demographics
NPI:1265498653
Name:BOLLINGER, BETH I (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:I
Last Name:BOLLINGER
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:1259 S CEDAR CREST BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6206
Mailing Address - Country:US
Mailing Address - Phone:610-437-4134
Mailing Address - Fax:610-433-9690
Practice Address - Street 1:236 BRODHEAD RD
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-8924
Practice Address - Country:US
Practice Address - Phone:610-437-4134
Practice Address - Fax:610-433-9690
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA052463363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100058GDKMedicare ID - Type Unspecified
PAQ67338Medicare UPIN