Provider Demographics
NPI:1598075293
Name:ANTHONY J BOLLINO,JR., M.D., PA
Entity Type:Organization
Organization Name:ANTHONY J BOLLINO,JR., M.D., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BOLLINO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD,PA
Authorized Official - Phone:301-729-6531
Mailing Address - Street 1:922 NATIONAL HWY
Mailing Address - Street 2:
Mailing Address - City:LAVALE
Mailing Address - State:MD
Mailing Address - Zip Code:21502-7325
Mailing Address - Country:US
Mailing Address - Phone:301-729-6531
Mailing Address - Fax:301-729-6897
Practice Address - Street 1:922 NATIONAL HWY
Practice Address - Street 2:
Practice Address - City:LAVALE
Practice Address - State:MD
Practice Address - Zip Code:21502-7325
Practice Address - Country:US
Practice Address - Phone:301-729-6531
Practice Address - Fax:301-729-6897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD220391000Medicaid
MD220391000Medicaid