Provider Demographics
NPI:1457463440
Name:HOLLANDER, JONATHAN A (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:A
Last Name:HOLLANDER
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 1:3000 COLBY ST
Mailing Address - Street 2:STE 203
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705
Mailing Address - Country:US
Mailing Address - Phone:510-369-2803
Mailing Address - Fax:510-849-2637
Practice Address - Street 1:3000 COLBY ST
Practice Address - Street 2:STE 203
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705
Practice Address - Country:US
Practice Address - Phone:510-369-2803
Practice Address - Fax:510-849-2637
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG28794207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G287940Medicaid
AH6989745OtherDEA
A43862Medicare UPIN
00G287940Medicare ID - Type Unspecified