Provider Demographics
NPI:1366734469
Name:BOLLER, VERONA MARIE (MD)
Entity type:Individual
Prefix:
First Name:VERONA
Middle Name:MARIE
Last Name:BOLLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VERONA
Other - Middle Name:MARIE
Other - Last Name:BAZELEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:101 NEW MEADOW RUN DR
Mailing Address - Street 2:PO BOX 10 ROUTE 40 EAST
Mailing Address - City:FARMINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15437-1391
Mailing Address - Country:US
Mailing Address - Phone:724-329-8689
Mailing Address - Fax:
Practice Address - Street 1:101 NEW MEADOW RUN DR
Practice Address - Street 2:ROUTE 40 EAST
Practice Address - City:FARMINGTON
Practice Address - State:PA
Practice Address - Zip Code:15437-1391
Practice Address - Country:US
Practice Address - Phone:724-329-8689
Practice Address - Fax:724-329-1230
Is Sole Proprietor?:No
Enumeration Date:2011-05-07
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD452351207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine