Provider Demographics
NPI:1205808870
Name:NOLAN, TIMOTHY LEO (MD)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:LEO
Last Name:NOLAN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2655 RIDGEWAY AVE
Mailing Address - Street 2:SUITE 480
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4296
Mailing Address - Country:US
Mailing Address - Phone:585-865-8210
Mailing Address - Fax:585-865-7597
Practice Address - Street 1:2655 RIDGEWAY AVE
Practice Address - Street 2:SUITE 480
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4296
Practice Address - Country:US
Practice Address - Phone:585-865-8210
Practice Address - Fax:585-865-7597
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2025-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY149002207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01015085Medicaid
NY01015085Medicaid
16584EMedicare ID - Type Unspecified
NYRB5233Medicare PIN