Provider Demographics
NPI:1518129717
Name:NOLAN, KATHLEEN (MD, MSL)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:
Last Name:NOLAN
Suffix:
Gender:F
Credentials:MD, MSL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16
Mailing Address - Street 2:
Mailing Address - City:MOUNT TREMPER
Mailing Address - State:NY
Mailing Address - Zip Code:12457-0016
Mailing Address - Country:US
Mailing Address - Phone:845-688-9702
Mailing Address - Fax:845-679-6973
Practice Address - Street 1:7194 STATE ROUTE 28
Practice Address - Street 2:
Practice Address - City:SHANDAKEN
Practice Address - State:NY
Practice Address - Zip Code:12480-5004
Practice Address - Country:US
Practice Address - Phone:845-688-9702
Practice Address - Fax:845-679-6973
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-28
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY175109208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics