Provider Demographics
NPI:1255363891
Name:BOLLING, KIMBERLY L (MD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:L
Last Name:BOLLING
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:14102 MARY BOWIE PKWY
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-8570
Mailing Address - Country:US
Mailing Address - Phone:240-245-3186
Mailing Address - Fax:
Practice Address - Street 1:4000 MITCHELLVILLE RD
Practice Address - Street 2:SUITE B424
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-3104
Practice Address - Country:US
Practice Address - Phone:301-352-0090
Practice Address - Fax:301-390-6029
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2016-07-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0058411207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD403713800Medicaid
MD403713800Medicaid
MDH58442Medicare UPIN