Provider Demographics
NPI:1952446528
Name:BOLLINGER, BETH A (MD)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:A
Last Name:BOLLINGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 BRYAN ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:16652-2413
Mailing Address - Country:US
Mailing Address - Phone:814-643-6300
Mailing Address - Fax:814-643-8776
Practice Address - Street 1:900 BRYAN ST
Practice Address - Street 2:SUITE 5
Practice Address - City:HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:16652-2413
Practice Address - Country:US
Practice Address - Phone:814-643-6300
Practice Address - Fax:814-643-8776
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD060186-L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01720276Medicaid
PA950768OtherBLUE SHIELD
PA01720276Medicaid
PA022266Medicare ID - Type Unspecified