Provider Demographics
NPI:1396847968
Name:KOLVA, DONALD GARY (MD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:GARY
Last Name:KOLVA
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 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-639-2978
Mailing Address - Fax:
Practice Address - Street 1:958 ISABEL DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-7482
Practice Address - Country:US
Practice Address - Phone:717-639-2978
Practice Address - Fax:717-412-1005
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD041574E2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA592094OtherBLUE SHIELD
PAMD041574EOtherLICENSE
PA1196001Medicaid
PA02326700OtherCAPITAL BLUE CROSS/KEYSTO
PABK1378442OtherDEA
PAMD041574EOtherLICENSE
PA592094OtherBLUE SHIELD
PA02326700OtherCAPITAL BLUE CROSS/KEYSTO