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General NPI Number Information
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NPI Number | 1316140304
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Entity Type | Organization
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Legal Business Name | MARK P. ROLLINS MD OF PENNSYLVANIA PC
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1009 WASHINGTON BLVD
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City | WILLIAMSPORT
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State | PA
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Zip | 17701-3633
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Country | US
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Telephone | 570-320-0189
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Fax |
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Provider Business Mailing Address
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Address Line | 10401 N MERIDIAN ST STE 310
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City | INDIANAPOLIS
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State | IN
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Zip | 46290-1151
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Country | US
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Telephone | 317-428-6909
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARK P. ROLLINS
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Credential | MD
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Telephone | 317-428-6909
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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