Provider Demographics
NPI:1124113485
Name:WOLFE, TIMOTHY (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:WOLFE
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:PO BOX 2150
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:NH
Mailing Address - Zip Code:03257-2150
Mailing Address - Country:US
Mailing Address - Phone:603-526-2911
Mailing Address - Fax:603-526-5085
Practice Address - Street 1:11 JOHN STARK HWY
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:NH
Practice Address - Zip Code:03773-1807
Practice Address - Country:US
Practice Address - Phone:603-526-5167
Practice Address - Fax:603-526-5085
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH6962207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
376708OtherMVP ID
NH81113014Medicaid
0103014YPNH01OtherANTHEM ID
2580OtherCIGNA ID
0103014YPNH01OtherANTHEM ID
376708OtherMVP ID
NH81113014Medicaid