Edward Randolph Noble Jr., M.D.

Primary specialty

Neuroradiology PhysicianTaxonomy code 2085N0700X

License

199779 Issued in NY

Practice address

5100 W Taft Rd
Suite 2a
Liverpool, NY 13088-3807

Phone

(315) 452-2555

Fax

(315) 452-2559

NPI assigned

Aug 18, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Central New York Pet LLC

  • Nuclear Medicine Physician
  • Liverpool, NY
  • NPI 1174515712
  NPD (past)
• Crouse Radiology Associates LLP

  • Diagnostic Radiology Physician
  • Syracuse, NY
  • NPI 1447244587
  NPD (past)
• Medical Imaging Center LLP

  • Radiology Clinic/Center
  • East Syracuse, NY
  • NPI 1538153671
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1124323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1189641600000",
    "number": "1063404820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4567 CROSSROADS PARK DR",
            "address_2": "2ND FLOOR",
            "city": "LIVERPOOL",
            "state": "NY",
            "postal_code": "130883589",
            "telephone_number": "315-295-2100",
            "fax_number": "315-295-2125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5100 W TAFT RD",
            "address_2": "SUITE 2A",
            "city": "LIVERPOOL",
            "state": "NY",
            "postal_code": "130883807",
            "telephone_number": "315-452-2555",
            "fax_number": "315-452-2559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NOBLE",
        "first_name": "EDWARD",
        "middle_name": "RANDOLPH",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-18",
        "last_updated": "2007-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085N0700X",
            "taxonomy_group": "",
            "desc": "Radiology, Neuroradiology",
            "state": "NY",
            "license": "199779",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00555500",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02224500",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0565508",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00555440",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tung D Nguyen, D.M.D.
• Peter William Nicolini, MST ATC
• Sophie Nielsen, PT, DPT
• NMC General Dentistry, PC
• Theodore Morgan Nnaji, PSYD
• Michael Robert Nolan, MD
• Robert S Nolan, MD
• Thomas Bennett Nolan, DDS
• North Area Medical Group P.C.
• North Area Medical Group, P.C.

• Neuroradiology Physician in Liverpool, NY
• Providers in Liverpool, NY by specialty
• Neuroradiology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.