Provider Demographics
NPI:1518211879
Name:GERARD MICHAEL NOLAN MD PC
Entity type:Organization
Organization Name:GERARD MICHAEL NOLAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPHTHALMOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:NOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-674-9627
Mailing Address - Street 1:1 FOREST PARK DR
Mailing Address - Street 2:P O BOX 827
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-1487
Mailing Address - Country:US
Mailing Address - Phone:860-674-9627
Mailing Address - Fax:860-676-8622
Practice Address - Street 1:1 FOREST PARK DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-1487
Practice Address - Country:US
Practice Address - Phone:860-674-9627
Practice Address - Fax:860-676-8622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT22587207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTB93948Medicare UPIN