Healthcare Provider Details

I. General information

NPI: 1982183034
Provider Name (Legal Business Name): NOLAN MICHAEL DOCHERTY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2018
Last Update Date: 10/17/2020
Certification Date: 10/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 MULBERRY ST
SCRANTON PA
18510-2369
US

IV. Provider business mailing address

1800 MULBERRY ST
SCRANTON PA
18510-2369
US

V. Phone/Fax

Practice location:
  • Phone: 570-703-8000
  • Fax:
Mailing address:
  • Phone: 570-703-8128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: