DR. WILLIAM A BOLLER III (NPI# 1972730380) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972730380 |
| Entity Type | Individual |
| Full Name | DR. WILLIAM A BOLLER III |
| Credential | M.D. |
| Practice Address |
1 Wahoo Ave Groton CT 06349-2324 |
| Practice Telephone | 8606942377 |
| Practice Fax Number | 8606942590 |
| Mailing Telephone | 8606942377 |
| Mailing Fax Number | 8606942590 |
| Enumeration Date | 2009-06-12 |
| Last Update Date | 2020-06-05 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 0101250100 | VA | Allopathic & Osteopathic Physicians |
| Street Address |
1 WAHOO AVE |
| City | GROTON |
| State | CT |
| Zip Code | 06349-2324 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043207004 | Matthew Braden Burns Miller | Dentist | 1 Wahoo Ave, Groton, CT 06349 | 2005-10-04 |
| 1063027407 | Jimmy Nazih Suliman | Dentist | 1 Wahoo Ave, Groton, CT 06349-2324 | 2020-09-12 |
| 1790395242 | Duc-nhan Nguyen Pham | Dentist | 1 Wahoo Ave, Groton, CT 06349-2324 | 2020-08-08 |
| 1770112708 | Amanda Kathleen Dobyns | Occupational Therapist | 1 Wahoo Ave, Groton, CT 06349-2324 | 2020-04-02 |
| 1831732825 | Cody Clark | Dentist | 1 Wahoo Ave, Groton, CT 06349-2324 | 2019-10-22 |
| 1477103059 | Jordan Taylor Rucinski | Dentist | 1 Wahoo Ave, Groton, CT 06349-2324 | 2019-09-16 |
| 1699335372 | Cynthia Daigneault | Counselor | 1 Wahoo Ave, Groton, CT 06349-2324 | 2019-06-16 |
| 1942868211 | Cameron Anson Martin | Military Health Care Provider | 1 Wahoo Ave, Groton, CT 06340 | 2019-06-03 |
| 1104386903 | Zena Sabath | General Practice | 1 Wahoo Ave, Groton, CT 06349-2324 | 2019-03-20 |
| 1538636527 | Winston Eugene Young | Dentist | 1 Wahoo Ave, Groton, CT 06349-2324 | 2018-10-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205434347 | Mvca | Optometrist | Navy Submarine Base New London, Bldg 484, Groton, CT 06349 | 2020-10-12 |
| 1376194274 | Christopher Lee Roy Smith | Military Health Care Provider | Uss San Juan (ssn 751), Groton, CT 06349 | 2019-09-23 |
| 1588127575 | Morgan Ross Jones | Student in an Organized Health Care Education/Training Program | Bx 159 Navsubase Nlon, Groton, CT 06349 | 2019-04-08 |
| 1689179640 | David Saunders | Military Health Care Provider | 159 Navsubase Nlon, Groton, CT 06349 | 2018-03-29 |
| 1013264423 | Dennis Buenaventura Custodio | Military Health Care Provider | 69 Trout Ave, Naval Undersea Medical Institute, Groton, CT 06349 | 2012-08-06 |
| 1609013549 | Nicolas David Mendoza | Military Health Care Provider | Uss Hawaii (ssn 776), Fpo, AE 06349 | 2009-01-14 |
| 1881843084 | Mark Francis Jarvis | Military Health Care Provider | Nssc Nlon, Bldg 76, Groton, CT 06349 | 2008-09-11 |
| 1780882738 | Michael Nutt | Military Health Care Provider | Bldg 517 Taugtog Ave, Navsubscol, Groton, CT 06349 | 2007-07-10 |
| 1497811343 | Keith Benjamin Hoekman | Nurse Practitioner | 1 Wahoo Dr, Groton, CT 06349 | 2006-12-28 |
| 1881604163 | Christina E Toufexis | Pediatrics | 1 Wahoo Drive, Groton, CT 06349 | 2006-08-09 |
| Find all providers in zip 06349 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780197715 | Yvonne J Sinclair | Family Medicine | 65 Merlino Dr, Groton, CT 06340-3149 | 2017-11-13 |
| 1982045969 | Jonathan Casey Brown | Family Medicine | 395 Hazelnut Hill Rd, Groton, CT 06340-3208 | 2013-07-08 |
| 1336434430 | Manju Mahajan | Family Medicine | 788 Boston Rd, Groton, MA 01450-2056 | 2011-06-16 |
| 1790970937 | Peter Clark, Md, PC | Family Medicine | 220 W South St, Groton, NY 13073-1237 | 2007-09-11 |
| 1306031976 | Avera St Luke's | Family Medicine | 8 E Us Highway 12, Groton, SD 57445-2176 | 2007-09-07 |
| 1427037159 | Ahmad M Mehdi | Family Medicine | 100 Sykes St, Groton, NY 13073 | 2006-01-11 |
| 1558345918 | John Christopher Daniel | Family Medicine | Trout Ave Bldg 141, Naval Submarine Medical Research Laboratory, Groton, CT 06349-5900 | 2005-11-30 |
| 1114918828 | Paul David Seeman | Family Medicine | Route 12 Bldg 449 Professional Affairs, Naval Ambulatory Care Center, Groton, CT 06349-5600 | 2005-11-02 |
| 1710978739 | Joel Walter Larcombe | Family Medicine | Route 12 Bldg 449, Naval Ambulatory Care Center Attn Professional Affairs, Groton, CT 06349-5600 | 2005-10-31 |
| 1588984264 | Tisha N. Dickey | Family Medicine | 1 Forge Village Rd, Groton, MA 01450-2047 | 2010-06-04 |
| Find all providers in GROTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.