Provider Demographics
NPI:1063654796
Name:NOGGLE, CHAD ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:ALLEN
Last Name:NOGGLE
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 1:901 W JEFFERSON ST
Mailing Address - Street 2:PO BOX 19642
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-4833
Mailing Address - Country:US
Mailing Address - Phone:217-545-8229
Mailing Address - Fax:217-545-2275
Practice Address - Street 1:901 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-4833
Practice Address - Country:US
Practice Address - Phone:217-545-8229
Practice Address - Fax:217-545-2275
Is Sole Proprietor?:No
Enumeration Date:2009-03-26
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN20042289A103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL256510017Medicare PIN