Healthcare Provider Details

I. General information

NPI: 1235793589
Provider Name (Legal Business Name): LIUDA NOLAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LIUDA NOLAN MD

II. Dates (important events)

Enumeration Date: 04/23/2019
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date: 12/04/2019
Reactivation Date: 12/11/2019

III. Provider practice location address

565 ABBOTT RD
BUFFALO NY
14220-2039
US

IV. Provider business mailing address

77 GOODALL STREET, SUIT 550
BUFFALO NY
14203
US

V. Phone/Fax

Practice location:
  • Phone: 716-364-8993
  • Fax:
Mailing address:
  • Phone: 716-829-6104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number322336-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: