Provider Demographics
NPI:1386307312
Name:BOLLINGER, MATTHEW CARROLL
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:CARROLL
Last Name:BOLLINGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 GLEN VIEW TER
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:MD
Mailing Address - Zip Code:21009-3109
Mailing Address - Country:US
Mailing Address - Phone:410-937-3409
Mailing Address - Fax:
Practice Address - Street 1:658 BOULTON ST STE A
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4563
Practice Address - Country:US
Practice Address - Phone:855-546-1096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-17
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA5436225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant