Provider Demographics
NPI:1982280731
Name:NOLAN, ROBERT CARL (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:CARL
Last Name:NOLAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 E HAMILTON AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-0251
Mailing Address - Country:US
Mailing Address - Phone:408-357-1410
Mailing Address - Fax:
Practice Address - Street 1:50 E HAMILTON AVE STE 120
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-0251
Practice Address - Country:US
Practice Address - Phone:408-357-1410
Practice Address - Fax:408-357-1410
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA201570207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program