Individual
KATHLEEN NOLL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
169 RIVERSIDE DR, BINGHAMTON, NY 13905-4198
(607) 722-7264
(607) 722-7869
Mailing address
40 FRONT ST STE C, BINGHAMTON, NY 13905-4712
(607) 722-7264
(607) 722-7869
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
MD030519E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001057410
—
PA
01
—
0021521000
KEYSTONE HEALTH PLAN EAST
PA
01
—
425863
PA BLUE SHIELD
PA
Enumeration date
06/22/2006
Last updated
08/09/2019
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