Organization
EASTERN PA NEPHROLOGY ASSOC P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAVINDRA BOLLU MD (PRESIDENT)
(610) 432-4529
Entity
Organization
Contact information
Practice address
1230 S CEDAR CREST BLVD, SUITE 301, ALLENTOWN, PA 18103-6212
(610) 432-4529
(610) 432-2206
Mailing address
1230 S CEDAR CREST BLVD, SUITE 301, ALLENTOWN, PA 18103-6212
(610) 432-4529
(610) 432-2206
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1003633
—
PA
01
—
CB0122
RR MEDICARE
—
Enumeration date
03/15/2006
Last updated
10/06/2010
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