Provider Demographics
NPI:1821332743
Name:NOLL, PAUL GREGORY
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:GREGORY
Last Name:NOLL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 E FORREST AVE
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:PA
Mailing Address - Zip Code:17361-1403
Mailing Address - Country:US
Mailing Address - Phone:717-227-4300
Mailing Address - Fax:717-227-4301
Practice Address - Street 1:72 E FORREST AVE
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:PA
Practice Address - Zip Code:17361-1403
Practice Address - Country:US
Practice Address - Phone:717-227-4300
Practice Address - Fax:717-227-4301
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAFO3285174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist