Healthcare Provider Details

I. General information

NPI: 1144295312
Provider Name (Legal Business Name): MARC ANTONY NOLAN M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 E 55TH ST APT 1F
NEW YORK NY
10022-5140
US

IV. Provider business mailing address

301 E 79TH ST APT 12J
NEW YORK NY
10075-0938
US

V. Phone/Fax

Practice location:
  • Phone: 212-400-9951
  • Fax: 212-737-7310
Mailing address:
  • Phone: 212-400-9951
  • Fax: 212-737-7310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number213416
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number213416
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: