Basic Information
| Provider Information | |||||||||
| NPI: | 1306930011 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OLSEN | ||||||||
| FirstName: | NOEL | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | M.D., | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1030 PRESIDENT AVENUE | ||||||||
| Address2: | SUITE 306 | ||||||||
| City: | FALL RIVER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086763411 | ||||||||
| FaxNumber: | 5086461576 | ||||||||
| Practice Location | |||||||||
| Address1: | 1030 PRESIDENT AVENUE | ||||||||
| Address2: | SUITE 306 | ||||||||
| City: | FALL RIVER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086763411 | ||||||||
| FaxNumber: | 5086461576 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 36504 | MA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 0006601 | 01 | MA | NEIGHBORHOOD HEALTH PLANS | OTHER | 454629 | 01 | MA | AETNA US HEALTHCARE | OTHER | 11015 | 01 | MA | HARVARD PILGRIM | OTHER | 9723889 | 05 | MA | MEDICAID | SO 07787 | 01 | CHAMPUS | OTHER | 706630 | 01 | MA | TUFTS HEALTH PLANS | OTHER | 104517 | 01 | RI | BLUECHIP | OTHER | 4517-7 | 01 | RI | RI BCBS | OTHER | 0501000 | 01 | MA | UNITED HEALTHCARE | OTHER | NO 00985 | 01 | RI | EDS RI MEDICAID | OTHER | 000000024259 | 01 | MA | BOSTON MEDICAL HEALTHNET | OTHER |