Provider Demographics
NPI:1427003664
Name:NOLAN, MARY S (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:S
Last Name:NOLAN
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 1:5855 E STAPLETON DR N
Mailing Address - Street 2:SUITE #A-130
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80216-3318
Mailing Address - Country:US
Mailing Address - Phone:303-371-7444
Mailing Address - Fax:303-371-7364
Practice Address - Street 1:5855 E STAPLETON DR N
Practice Address - Street 2:SUITE #A-130
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80216-3318
Practice Address - Country:US
Practice Address - Phone:303-371-7444
Practice Address - Fax:303-371-7364
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO27508207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMA005OtherTRICARE
CO01275080Medicaid
COE36753Medicare UPIN