Provider Demographics
NPI:1831217629
Name:GAETON T. NOLA, M.D., A MEDICAL CORP.
Entity type:Organization
Organization Name:GAETON T. NOLA, M.D., A MEDICAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GAETON
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:NOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-356-2244
Mailing Address - Street 1:15047 LOS GATOS BLVD
Mailing Address - Street 2:STE. 150
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2054
Mailing Address - Country:US
Mailing Address - Phone:408-356-2244
Mailing Address - Fax:408-395-4049
Practice Address - Street 1:15047 LOS GATOS BLVD
Practice Address - Street 2:STE. 150
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2054
Practice Address - Country:US
Practice Address - Phone:408-356-2244
Practice Address - Fax:408-395-4849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A44526Medicare UPIN
CA00G307290Medicare ID - Type Unspecified