Healthcare Provider Details

I. General information

NPI: 1730455262
Provider Name (Legal Business Name): MICHAEL JOSEPH NOLAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2012
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 STATION AVE STE 202
BRUNSWICK ME
04011-2092
US

IV. Provider business mailing address

22 STATION AVE STE 202
BRUNSWICK ME
04011-2092
US

V. Phone/Fax

Practice location:
  • Phone: 207-725-7971
  • Fax: 207-810-2374
Mailing address:
  • Phone: 207-725-7971
  • Fax: 207-810-2374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD21166
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: