Provider Demographics
NPI:1992236244
Name:BOLLA, MARIA (DPM)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:BOLLA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:264 BEACON ST STE 201
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-1294
Mailing Address - Country:US
Mailing Address - Phone:617-262-2266
Mailing Address - Fax:617-262-2261
Practice Address - Street 1:264 BEACON ST STE 201
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-1294
Practice Address - Country:US
Practice Address - Phone:617-262-2266
Practice Address - Fax:617-262-2261
Is Sole Proprietor?:No
Enumeration Date:2017-03-27
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA2500213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist