Provider Demographics
NPI:1144421710
Name:SERENA R. NOLAN, M.D., PA
Entity Type:Organization
Organization Name:SERENA R. NOLAN, M.D., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SERENA
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:NOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-668-4300
Mailing Address - Street 1:8831 SATYR HILL RD
Mailing Address - Street 2:STE. 100
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-2306
Mailing Address - Country:US
Mailing Address - Phone:410-668-4300
Mailing Address - Fax:410-668-3744
Practice Address - Street 1:8831 SATYR HILL RD
Practice Address - Street 2:STE 100
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21234-4230
Practice Address - Country:US
Practice Address - Phone:410-668-4300
Practice Address - Fax:410-668-3744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0025010207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD329601600Medicaid
D76305Medicare UPIN