Provider Demographics
NPI:1023153350
Name:ROBERT B. NOLAN, JR., MD, PLLC
Entity type:Organization
Organization Name:ROBERT B. NOLAN, JR., MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:BOND
Authorized Official - Last Name:NOLAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:502-451-9296
Mailing Address - Street 1:4119 BROWNS LN
Mailing Address - Street 2:STE. 1
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-1500
Mailing Address - Country:US
Mailing Address - Phone:502-451-9296
Mailing Address - Fax:502-451-9291
Practice Address - Street 1:4119 BROWNS LN
Practice Address - Street 2:STE. 1
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-1500
Practice Address - Country:US
Practice Address - Phone:502-451-9296
Practice Address - Fax:502-451-9291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA353363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7893Medicare PIN