Provider Demographics
NPI:1336156785
Name:BOLLINGER, JAMES RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:RICHARD
Last Name:BOLLINGER
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 1:209 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
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD014743E208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007280280002Medicaid
PA019844GP7Medicare ID - Type Unspecified
PAB33420Medicare UPIN