Provider Demographics
NPI:1497720676
Name:NOLAN, ROBERT S (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:NOLAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 W TAFT RD STE 2T
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-4841
Mailing Address - Country:US
Mailing Address - Phone:315-744-1592
Mailing Address - Fax:315-744-1961
Practice Address - Street 1:5100 W TAFT RD STE 2T
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-4841
Practice Address - Country:US
Practice Address - Phone:315-744-1592
Practice Address - Fax:315-744-1961
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235018207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02658111Medicaid
NYRA6919Medicare ID - Type Unspecified
NYI31469Medicare UPIN
NYRB0784Medicare PIN
NYRB7951Medicare PIN