Provider Demographics
NPI:1528314259
Name:MOTT, NOLAN K (DO)
Entity type:Individual
Prefix:
First Name:NOLAN
Middle Name:K
Last Name:MOTT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:155 CRYSTAL RUN RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941-4028
Mailing Address - Country:US
Mailing Address - Phone:845-703-6999
Mailing Address - Fax:845-703-6297
Practice Address - Street 1:301 MEMORIAL MEDICAL PKWY
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5167
Practice Address - Country:US
Practice Address - Phone:407-975-0410
Practice Address - Fax:407-975-0407
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2023-06-30
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Provider Licenses
StateLicense IDTaxonomies
NY273061208000000X, 208M00000X
FLOS11720208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist