Provider Demographics
NPI:1992741375
Name:NOLT, JEFFREY SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:SCOTT
Last Name:NOLT
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 1:1001 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:COUDERSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:16915-8161
Mailing Address - Country:US
Mailing Address - Phone:814-274-7407
Mailing Address - Fax:814-274-0807
Practice Address - Street 1:71 ELK ST
Practice Address - Street 2:
Practice Address - City:COUDERSPORT
Practice Address - State:PA
Practice Address - Zip Code:16915-9601
Practice Address - Country:US
Practice Address - Phone:814-274-5577
Practice Address - Fax:814-274-8709
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038732E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001098969Medicaid
PA4380633OtherAETNA
PA50054398OtherCAPITAL BLUE CROSS-WMG
PA001098969Medicaid
PA20069241OtherAMERIHEALTH MERCY-WMG
PA444122OtherHIGHMARK BLUE SHIELD
MD634059OtherCAREFIRST MD BCBS
PA444122FLTMedicare PIN
PAP00259903Medicare PIN
B41898Medicare UPIN
PA70078OtherGEISINGER
PA102360OtherJOHNS HOPKINS
PA170952OtherUNISON-WMG