Provider Demographics
NPI:1215147723
Name:WOLFF ORTHOPEDIC AND SPORTS MEDICINE ASSOCIATES, P.A.
Entity type:Organization
Organization Name:WOLFF ORTHOPEDIC AND SPORTS MEDICINE ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-964-4887
Mailing Address - Street 1:805 E OLDTOWN RD STE B
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-4053
Mailing Address - Country:US
Mailing Address - Phone:240-410-0401
Mailing Address - Fax:
Practice Address - Street 1:805 E OLDTOWN RD STE B
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-4053
Practice Address - Country:US
Practice Address - Phone:240-964-4887
Practice Address - Fax:240-964-4883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0048127207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD171992OtherMEDICARE PTAN
MD490QMedicare PIN
MD6378980001Medicare NSC