Provider Demographics
NPI:1821017112
Name:NOLL, ROBERT K (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:K
Last Name:NOLL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1350 EDGMONT AVE
Mailing Address - Street 2:STE 1500
Mailing Address - City:CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19013-3962
Mailing Address - Country:US
Mailing Address - Phone:610-619-7410
Mailing Address - Fax:610-876-8483
Practice Address - Street 1:30 MEDICAL CENTER BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013-3955
Practice Address - Country:US
Practice Address - Phone:610-619-7410
Practice Address - Fax:610-876-8483
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2018-09-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD433330208D00000X, 208M00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4141776Medicaid
NJ8730806Medicaid
PA102074276Medicaid
PA102074276Medicaid