Healthcare Provider Details

I. General information

NPI: 1720177231
Provider Name (Legal Business Name): ROBERT NOLFO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 06/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 BROAD ST
GUILFORD CT
06437
US

IV. Provider business mailing address

152 BROAD ST
GUILFORD CT
06437
US

V. Phone/Fax

Practice location:
  • Phone: 203-453-5235
  • Fax: 203-453-6204
Mailing address:
  • Phone: 203-453-5235
  • Fax: 203-453-6204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036091
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: