Healthcare Provider Details

I. General information

NPI: 1922067297
Provider Name (Legal Business Name): PATRICK MICHAEL NOLAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 COURAGE DR
FAIRFIELD CA
94533-6717
US

IV. Provider business mailing address

77 SOLANO SQ #182
BENICIA CA
94510-2712
US

V. Phone/Fax

Practice location:
  • Phone: 707-784-2080
  • Fax:
Mailing address:
  • Phone: 707-342-1813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA83942
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: