Provider Demographics
NPI:1770557928
Name:BOLGER, JOHN F (PSYD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:F
Last Name:BOLGER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 WEST MONTGOMERY AVE
Mailing Address - Street 2:
Mailing Address - City:HATBORO
Mailing Address - State:PA
Mailing Address - Zip Code:19040-3119
Mailing Address - Country:US
Mailing Address - Phone:267-614-1107
Mailing Address - Fax:
Practice Address - Street 1:142 EAST MORELAND AVE
Practice Address - Street 2:
Practice Address - City:HATBORO
Practice Address - State:PA
Practice Address - Zip Code:19040-4714
Practice Address - Country:US
Practice Address - Phone:215-956-0333
Practice Address - Fax:215-956-0308
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS015487103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical