Provider Demographics
NPI:1104297647
Name:WILLIAM R. WOLFE, M.D., PC
Entity type:Organization
Organization Name:WILLIAM R. WOLFE, M.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-558-8778
Mailing Address - Street 1:1 N BACTON HILL RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:FRAZER
Mailing Address - State:PA
Mailing Address - Zip Code:19355-1047
Mailing Address - Country:US
Mailing Address - Phone:877-558-8778
Mailing Address - Fax:610-903-4281
Practice Address - Street 1:1 N BACTON HILL RD
Practice Address - Street 2:SUITE 208
Practice Address - City:FRAZER
Practice Address - State:PA
Practice Address - Zip Code:19355-1047
Practice Address - Country:US
Practice Address - Phone:877-558-8778
Practice Address - Fax:610-903-4281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-09
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA061958002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG06834Medicare UPIN
NJ640098Medicare PIN