Provider Demographics
NPI:1588978779
Name:MARGARET J. NOLAN, M.D. PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:MARGARET J. NOLAN, M.D. PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:JOYCE
Authorized Official - Last Name:NOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-281-5274
Mailing Address - Street 1:PO BOX 1554
Mailing Address - Street 2:
Mailing Address - City:SANDIA PARK
Mailing Address - State:NM
Mailing Address - Zip Code:87047-1554
Mailing Address - Country:US
Mailing Address - Phone:505-281-5274
Mailing Address - Fax:505-247-9035
Practice Address - Street 1:1505 LOS ALAMOS AVE SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87104-1119
Practice Address - Country:US
Practice Address - Phone:505-281-5274
Practice Address - Fax:505-247-9035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4318218207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty