Provider Demographics
NPI:1427111830
Name:PATRICK M NOLAN DO INC
Entity type:Organization
Organization Name:PATRICK M NOLAN DO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:M
Authorized Official - Last Name:NOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:907-561-6100
Mailing Address - Street 1:3300 PROVIDENCE DRIVE
Mailing Address - Street 2:#206
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4620
Mailing Address - Country:US
Mailing Address - Phone:907-561-6100
Mailing Address - Fax:907-563-4265
Practice Address - Street 1:3300 PROVIDENCE DRIVE
Practice Address - Street 2:SUI 206
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4620
Practice Address - Country:US
Practice Address - Phone:907-561-6100
Practice Address - Fax:907-563-4265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA1470207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD1470Medicaid
AKMD1470Medicaid
AKK0000LGBLPMedicare PIN