Provider Demographics
NPI:1932142031
Name:NOLAN, JOHN P (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:NOLAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:301 LIPPINCOTT DR STE 410
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4197
Mailing Address - Country:US
Mailing Address - Phone:856-355-0340
Mailing Address - Fax:856-355-0330
Practice Address - Street 1:1600 HADDON AVE
Practice Address - Street 2:ROOM 122
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-3101
Practice Address - Country:US
Practice Address - Phone:856-757-3872
Practice Address - Fax:856-365-4010
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MB04857900208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1617206Medicaid
586404OtherINDEPENDENCE BCBS
NJ1092796OtherHORIZON NJ HEALTH
2K7019OtherHEALTHNET
0936901001OtherCIGNA
NJ732400OtherAMERICAID
048137000OtherAMERIHEALTH / KEYSTONE
NJ250002698OtherRAILROAD MEDICARE
4223926OtherAETNA
NJ222445694OtherTAX ID
048137000OtherAMERIHEALTH / KEYSTONE
NJ1617206Medicaid