Healthcare Provider Details

I. General information

NPI: 1720571565
Provider Name (Legal Business Name): NOLAN FENZL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5951 BUNTING RD
ORCHARD PARK NY
14127-3604
US

IV. Provider business mailing address

5951 BUNTING RD
ORCHARD PARK NY
14127-3604
US

V. Phone/Fax

Practice location:
  • Phone: 716-997-0907
  • Fax:
Mailing address:
  • Phone: 716-997-0907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number71696
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: