Provider Demographics
NPI:1063654796
Name:NOGGLE, CHAD ALLEN (MD)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:ALLEN
Last Name:NOGGLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1005 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-2834
Mailing Address - Country:US
Mailing Address - Phone:217-223-1200
Mailing Address - Fax:217-277-3960
Practice Address - Street 1:927 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-2719
Practice Address - Country:US
Practice Address - Phone:217-224-4453
Practice Address - Fax:217-224-9383
Is Sole Proprietor?:No
Enumeration Date:2009-03-26
Last Update Date:2024-07-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN20042289A103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL256510017Medicare PIN