Provider Demographics
NPI:1710159926
Name:RICHARD A. NOLAN, M.D., INC.
Entity Type:Organization
Organization Name:RICHARD A. NOLAN, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:NOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-523-4040
Mailing Address - Street 1:2100 OTIS DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-5780
Mailing Address - Country:US
Mailing Address - Phone:510-523-4040
Mailing Address - Fax:
Practice Address - Street 1:2100 OTIS DR
Practice Address - Street 2:SUITE B
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-5780
Practice Address - Country:US
Practice Address - Phone:510-523-4040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA24017207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAW479AMedicare PIN