Active NPI
William Edward Noller, M.D.
- Family Medicine Physician
- Richmond, VA
National Provider Identifier
1023049228
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 0101041328
- Practice address
- 4620 S Laburnum Ave
Richmond, VA 23231-2424 - Phone
- (804) 652-2200
- Fax
- (804) 222-0458
- NPI assigned
- Jul 5, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 0101041328 | VA | Primary |
Addresses
Primary practice location
4620 S Laburnum Ave
Richmond, VA 23231-2424
Mailing address
4620 S Laburnum Ave
Richmond, VA 23231-2424
Phone (804) 652-2200
Other identifiers 9
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 79151 | Other | VA | SOUTHERN HEALTH SERVICES |
| 293612 | Other | VA | MAMSI |
| 12673 | Other | VA | SENTARA |
| 333716 | Other | VA | ANTHEM BCBS OF VA |
| 4206388 | Other | VA | AETNA LIFE |
| 4206388 | Other | VA | AETNA HMO |
| 005613159 | Medicaid | VA | |
| 0856408 | Other | VA | CIGNA |
| 080125347 | Other | VA | RAILROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152057600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1259020800000",
"number": "1023049228",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4620 S LABURNUM AVE",
"city": "RICHMOND",
"state": "VA",
"postal_code": "232312424",
"telephone_number": "804-652-2200",
"fax_number": "804-222-0458"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4620 S LABURNUM AVE",
"city": "RICHMOND",
"state": "VA",
"postal_code": "232312424",
"telephone_number": "804-652-2200",
"fax_number": "804-222-0458"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NOLLER",
"first_name": "WILLIAM",
"middle_name": "EDWARD",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-05",
"last_updated": "2009-11-24",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "VA",
"license": "0101041328",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SOUTHERN HEALTH SERVICES",
"identifier": "79151",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAMSI",
"identifier": "293612",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SENTARA",
"identifier": "12673",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BCBS OF VA",
"identifier": "333716",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA LIFE",
"identifier": "4206388",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA HMO",
"identifier": "4206388",
"state": "VA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "005613159",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "0856408",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "080125347",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Richmond, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.