Basic Information
| Provider Information | |||||||||
| NPI: | 1417967191 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZOLLER | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 829641 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191829641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2673705296 | ||||||||
| FaxNumber: | 2152303725 | ||||||||
| Practice Location | |||||||||
| Address1: | 708 N SHADY RETREAT RD STE 5 | ||||||||
| Address2: | |||||||||
| City: | DOYLESTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189012503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2153485888 | ||||||||
| FaxNumber: | 2153487001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2006 | ||||||||
| LastUpdateDate: | 03/04/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD021655E | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.