Provider Demographics
NPI:1013982875
Name:NOLAN, JOHN W (PA)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:NOLAN
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:1400 VFW PKWY
Mailing Address - Street 2:
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-4927
Mailing Address - Country:US
Mailing Address - Phone:781-801-2168
Mailing Address - Fax:774-826-2132
Practice Address - Street 1:100 TER HEUN DRIVE
Practice Address - Street 2:FALMOUTH HOSPITAL EMERGENCY DEPARTMENT
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540
Practice Address - Country:US
Practice Address - Phone:508-457-3929
Practice Address - Fax:508-457-3839
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2024-12-19
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Provider Licenses
StateLicense IDTaxonomies
MA872363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P12345Medicare UPIN
AP1312Medicare ID - Type Unspecified