MEDICARE: DAVID A BOLLARD DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	25MB05026800	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831185768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID A BOLLARD DO

Provider Business Mailing Address
First Line	:	532 LAFAYETTE RD
Second Line	:	SUITE 300
City	:	SPARTA
State	:	NJ
Zip	:	07871-4411
Country	:	US
Telephone Number	:	973-940-0423
Fax Number	:	973-940-0399

Provider Business Practice Location Address
First Line	:	89 SPARTA AVE
Second Line	:	SUITE 100
City	:	SPARTA
State	:	NJ
Zip	:	07871-1777
Country	:	US
Telephone Number	:	973-729-2121
Fax Number	:	973-729-3454

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2005
Last Update Date	:	10/20/2011

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Directions to “ DAVID A BOLLARD DO” Practice Location

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