Healthcare Provider Details

I. General information

NPI: 1295354579
Provider Name (Legal Business Name): RYAN PATRICK NOLAN MD, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2020
Last Update Date: 09/12/2026
Certification Date: 09/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 CREEKSHIRE WAY STE 100
WINSTON SALEM NC
27103-3148
US

IV. Provider business mailing address

1340 CREEKSHIRE WAY STE 100
WINSTON SALEM NC
27103-3148
US

V. Phone/Fax

Practice location:
  • Phone: 336-768-3240
  • Fax: 336-701-4035
Mailing address:
  • Phone: 336-768-3240
  • Fax: 336-701-4035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number2024-00949
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number202400949
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: