Provider Demographics
NPI:1366407553
Name:WOLLIN, ERNEST (MD)
Entity type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:
Last Name:WOLLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1524 PINE BAY DR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-3550
Mailing Address - Country:US
Mailing Address - Phone:941-349-1868
Mailing Address - Fax:941-349-9170
Practice Address - Street 1:1524 PINE BAY DR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-3550
Practice Address - Country:US
Practice Address - Phone:941-349-1868
Practice Address - Fax:941-349-9170
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00088702085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL261042600Medicaid
FL35074OtherBLUE CROSS BLUE SHIELD
FL300129387OtherRAILROAD MEDICARE
FL261042600Medicaid
FL35074BMedicare ID - Type Unspecified