Basic Information
| Provider Information | |||||||||
| NPI: | 1821017112 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NOLL | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1350 EDGMONT AVE | ||||||||
| Address2: | STE 1500 | ||||||||
| City: | CHESTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190133962 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106197410 | ||||||||
| FaxNumber: | 6108768483 | ||||||||
| Practice Location | |||||||||
| Address1: | 30 MEDICAL CENTER BLVD | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | CHESTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190133955 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106197410 | ||||||||
| FaxNumber: | 6108768483 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 09/13/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | MD433330 | PA | N | Allopathic & Osteopathic Physicians | General Practice | 208M00000X | MD433330 | PA | N | Allopathic & Osteopathic Physicians | Hospitalist | 208000000X | MD433330 | PA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 4141776 | 05 | MD | MEDICAID | 8730806 | 05 | NJ | MEDICAID | 102074276 | 05 | PA | MEDICAID |