Provider Demographics
NPI:1144413980
Name:KOLODEJ, VERA A (MD)
Entity type:Individual
Prefix:
First Name:VERA
Middle Name:A
Last Name:KOLODEJ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 768165
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-8165
Mailing Address - Country:US
Mailing Address - Phone:770-552-0258
Mailing Address - Fax:
Practice Address - Street 1:8725 ROSUELL RD.
Practice Address - Street 2:SUITE 0 #211
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30350
Practice Address - Country:US
Practice Address - Phone:770-552-0258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA52167207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine