Healthcare Provider Details

I. General information

NPI: 1629509054
Provider Name (Legal Business Name): LAWRENCE J NOLAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 11/22/2023
Certification Date: 11/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GRESHAM DR STE 8630B
NORFOLK VA
23507-1904
US

IV. Provider business mailing address

47 NEW SCOTLAND AVE DEPT. OF NEUROLOGY
ALBANY NY
12208-3412
US

V. Phone/Fax

Practice location:
  • Phone: 757-388-6115
  • Fax: 757-275-9998
Mailing address:
  • Phone: 518-262-3593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number63918
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License Number0102208047
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: