Provider Demographics
NPI:1780765511
Name:KOLLMAN, PAUL V (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:V
Last Name:KOLLMAN
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:PO BOX 637676
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-0001
Mailing Address - Country:US
Mailing Address - Phone:513-569-6386
Mailing Address - Fax:513-569-6320
Practice Address - Street 1:100 ARROW SPRINGS BLVD
Practice Address - Street 2:SUITE 2700
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-9863
Practice Address - Country:US
Practice Address - Phone:513-282-7300
Practice Address - Fax:513-282-7310
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35208375207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0203916Medicaid
OH4142405Medicare PIN
OH4142409Medicare PIN
OH4142402Medicare PIN
OH0203916Medicaid
OH4142408Medicare PIN
OH4142403Medicare PIN