Healthcare Provider Details

I. General information

NPI: 1992387039
Provider Name (Legal Business Name): MARINE PASCALE BOLLIET MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2021
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E BROAD ST BOX 980167
RICHMOND VA
23298-0011
US

IV. Provider business mailing address

1200 E BROAD ST BOX 980167
RICHMOND VA
23298-0011
US

V. Phone/Fax

Practice location:
  • Phone: 804-827-0049
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number0101289603
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4351048606APP21
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: