Provider Demographics
NPI:1902829856
Name:NOLAN, THOMAS EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:EDWARD
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 1:1340 POYDRAS ST
Mailing Address - Street 2:SUITE 1640
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-1221
Mailing Address - Country:US
Mailing Address - Phone:504-412-1860
Mailing Address - Fax:
Practice Address - Street 1:2020 GRAVIER STREET 7TH FLOOR
Practice Address - Street 2:OBSTETRICS GYNECOLOGY
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112
Practice Address - Country:US
Practice Address - Phone:504-412-1527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA09877R207R00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01123210Medicaid
LA1971766Medicaid
LA5R790Medicare PIN
LA1971766Medicaid
D42022Medicare UPIN