Provider Demographics
NPI:1871794610
Name:ANDREW R BOLMANN MD PC
Entity type:Organization
Organization Name:ANDREW R BOLMANN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:R
Authorized Official - Last Name:BOLMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-323-6077
Mailing Address - Street 1:2195 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-3235
Mailing Address - Country:US
Mailing Address - Phone:610-323-6077
Mailing Address - Fax:610-323-2760
Practice Address - Street 1:2195 E HIGH ST
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-3235
Practice Address - Country:US
Practice Address - Phone:610-323-6077
Practice Address - Fax:610-323-2760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD011574E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1326035692OtherNPI #
PABO988528OtherBLUE SHIELD
PAB34438Medicare UPIN
PABO52415Medicare ID - Type Unspecified