Provider Demographics
NPI:1871569210
Name:BOLEY, TIMOTHY (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:
Last Name:BOLEY
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 1:100 S 2ND ST STE 4B
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17101-2546
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 S 2ND ST STE 4B
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17101-2546
Practice Address - Country:US
Practice Address - Phone:717-231-8472
Practice Address - Fax:717-231-8490
Is Sole Proprietor?:No
Enumeration Date:2006-02-26
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD426303207VM0101X, 2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101301146Medicaid
PA000000169311OtherGATEWAY
PA001740376OtherHIGHMARK
PA1086483OtherAETNA-HMO
PA2407344000OtherINDEPENDENCE BLUE CROSS
PA001740376OtherHIGHMARK
PA094784Medicare ID - Type Unspecified
PA000000169311OtherUNISON
PA102907OtherGEISINGER
PA5809652OtherAETNA-NON HMO
PA50055811OtherCAPITAL BLUE CROSS/KEYSTONE HEALTH PLAN CENTRAL
PA20043789OtherMERCY