Provider Demographics
NPI:1679576813
Name:NOLAN, JOSEPH EDWARD (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:EDWARD
Last Name:NOLAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9267 MEDICAL PLAZA DR
Mailing Address - Street 2:STE G
Mailing Address - City:N CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9139
Mailing Address - Country:US
Mailing Address - Phone:843-797-3636
Mailing Address - Fax:843-797-3637
Practice Address - Street 1:9267 MEDICAL PLAZA DR
Practice Address - Street 2:STE G
Practice Address - City:N CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9139
Practice Address - Country:US
Practice Address - Phone:843-797-3636
Practice Address - Fax:843-797-3637
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19839174400000X, 207L00000X, 207LP2900X, 208VP0014X
246ZG1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No174400000XOther Service ProvidersSpecialist
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No246ZG1000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGeneticist, Medical (PhD)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC352982100OtherOWCP
SC753062671OtherCOMPANION ID
SC080192298OtherRAILROAD MEDICARE
SC198397Medicaid
SC5370360001OtherMEDICARE DME
SC20017546OtherSELECT HEALTH/MEDICAID
SCG89621Medicare UPIN
SCG896215033Medicare ID - Type UnspecifiedMEDICARE PART B PROVIDER
SCG896217439Medicare PIN