Provider Demographics
NPI:1285655845
Name:BOLLIN, GARY E (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:E
Last Name:BOLLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:224 W EXCHANGE ST
Mailing Address - Street 2:SUITE 290
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44302-1704
Mailing Address - Country:US
Mailing Address - Phone:330-344-6643
Mailing Address - Fax:330-762-7196
Practice Address - Street 1:224 W EXCHANGE ST
Practice Address - Street 2:SUITE 290
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44302-1704
Practice Address - Country:US
Practice Address - Phone:330-344-6643
Practice Address - Fax:330-762-7196
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35046862207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0536138Medicaid
OH0570034OtherMEDICARE PTAN
OH0570034OtherMEDICARE PTAN