Provider Demographics
NPI:1801890140
Name:OLLER, CARLO AJ (MD)
Entity type:Individual
Prefix:DR
First Name:CARLO
Middle Name:AJ
Last Name:OLLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:825 E PRINCETON AVE
Mailing Address - Street 2:
Mailing Address - City:PALMERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18071-1412
Mailing Address - Country:US
Mailing Address - Phone:850-524-1771
Mailing Address - Fax:610-477-6571
Practice Address - Street 1:825 E PRINCETON AVE
Practice Address - Street 2:
Practice Address - City:PALMERTON
Practice Address - State:PA
Practice Address - Zip Code:18071-1412
Practice Address - Country:US
Practice Address - Phone:850-524-1771
Practice Address - Fax:610-477-6571
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD420038207P00000X
FLME95611207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001920615Medicaid
PA061985Medicare ID - Type Unspecified