Provider Demographics
NPI:1699747485
Name:OLINE, JONATHAN P (DO)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:P
Last Name:OLINE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 MIDDLETOWN BLVD
Mailing Address - Street 2:STE 604
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047
Mailing Address - Country:US
Mailing Address - Phone:215-750-6777
Mailing Address - Fax:215-752-0384
Practice Address - Street 1:390 MIDDLETOWN BLVD
Practice Address - Street 2:STE 604
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047
Practice Address - Country:US
Practice Address - Phone:215-750-6777
Practice Address - Fax:215-752-0384
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS005337L207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
E71358Medicare UPIN
453252Medicare ID - Type Unspecified