Individual
DR. CHARLES DAVID NOLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4131 OREGON PIKE, BROWNSTOWN, PA 17508-0489
(717) 859-1123
(717) 859-2898
Mailing address
PO BOX 489, 4131 OREGON PIKE, BROWNSTOWN, PA 17508-0489
(717) 859-1123
(717) 859-2898
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OS004463L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000680630010
—
PA
01
—
168421
THREE RIVERS
PA
01
—
4663115
AETNA/USHC
PA
01
—
52793
BLUE SHIELD
PA
01
—
P002398
GATEWAY
PA
Enumeration date
07/03/2006
Last updated
07/08/2007
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