Provider Demographics
NPI:1922112119
Name:JAMES R BOLLINGER, MD PC
Entity Type:Organization
Organization Name:JAMES R BOLLINGER, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:BOLLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-296-0810
Mailing Address - Street 1:209 W LANCASTER AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1749
Mailing Address - Country:US
Mailing Address - Phone:610-296-0810
Mailing Address - Fax:610-296-4968
Practice Address - Street 1:209 W LANCASTER AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1749
Practice Address - Country:US
Practice Address - Phone:610-296-0810
Practice Address - Fax:610-296-4968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD014743E208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0886036Medicaid
PA0886036Medicaid