Basic Information
| Provider Information | |||||||||
| NPI: | 1659721710 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NOLAN | ||||||||
| FirstName: | JOHN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17 BERWICK RD | ||||||||
| Address2: | |||||||||
| City: | MEDFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021556017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5186946022 | ||||||||
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| Practice Location | |||||||||
| Address1: | 20 PONDMEADOW DR STE 203 | ||||||||
| Address2: | |||||||||
| City: | READING | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018673261 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6175062726 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2016 | ||||||||
| LastUpdateDate: | 07/16/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 267864 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207W00000X | 283374 | MA | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.