Provider Demographics
NPI:1760484935
Name:NOLL, JEAN M (MD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:M
Last Name:NOLL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 631662
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-1662
Mailing Address - Country:US
Mailing Address - Phone:859-581-7120
Mailing Address - Fax:859-581-7207
Practice Address - Street 1:500 THOMAS MORE PKWY
Practice Address - Street 2:
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-3454
Practice Address - Country:US
Practice Address - Phone:859-341-4525
Practice Address - Fax:859-341-4993
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY23456207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100374340Medicaid
180021901OtherMEDICARE RAILROAD
OH0667505Medicaid
KY64234560Medicaid
OH0696732Medicare PIN
KY0651110Medicare PIN
KY0344303Medicare PIN
180021901OtherMEDICARE RAILROAD
OH0667505Medicaid