Provider Demographics
NPI:1528060928
Name:BOLLINO, ANTHONY JOSEPH JR (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:JOSEPH
Last Name:BOLLINO
Suffix:JR
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 1:922 NATIONAL HWY
Mailing Address - Street 2:
Mailing Address - City:LAVALE
Mailing Address - State:MD
Mailing Address - Zip Code:21502-7325
Mailing Address - Country:US
Mailing Address - Phone:301-729-6877
Mailing Address - Fax:301-729-6897
Practice Address - Street 1:922 NATIONAL HWY
Practice Address - Street 2:
Practice Address - City:LAVALE
Practice Address - State:MD
Practice Address - Zip Code:21502-7325
Practice Address - Country:US
Practice Address - Phone:301-729-6877
Practice Address - Fax:301-729-6897
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0017565207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine