Individual
MR. JOHN N. BOLL JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
740 HIGH ST, SUITE 4001, WILLIAMSPORT, PA 17701-3100
(570) 321-2345
(570) 321-2359
Mailing address
1201 GRAMPIAN BLVD, WILLIAMSPORT, PA 17701-1900
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OS010395L
PA
207VX0000X
Obstetrics Physician
OS010395L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1026698040001
—
PA
05
—
64052707
—
KY
Enumeration date
05/24/2005
Last updated
04/16/2021
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