Provider Demographics
NPI:1417971920
Name:NOLFO, EMILY A (MD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:A
Last Name:NOLFO
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 1:5 DURHAM RD STE C2
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-2076
Mailing Address - Country:US
Mailing Address - Phone:203-488-4334
Mailing Address - Fax:203-488-7400
Practice Address - Street 1:5 DURHAM RD STE C2
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2076
Practice Address - Country:US
Practice Address - Phone:203-488-4334
Practice Address - Fax:203-488-7400
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT30894207R00000X
CT030894207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001338940Medicaid