Provider Demographics
NPI:1215925235
Name:WOLF, ROBERT JORDAN (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:JORDAN
Last Name:WOLF
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 COLONIAL WAY STE B
Mailing Address - Street 2:
Mailing Address - City:RISING SUN
Mailing Address - State:MD
Mailing Address - Zip Code:21911-2272
Mailing Address - Country:US
Mailing Address - Phone:443-485-9116
Mailing Address - Fax:877-426-3121
Practice Address - Street 1:101 COLONIAL WAY STE B
Practice Address - Street 2:
Practice Address - City:RISING SUN
Practice Address - State:MD
Practice Address - Zip Code:21911-2272
Practice Address - Country:US
Practice Address - Phone:443-485-9116
Practice Address - Fax:877-426-3121
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0066323207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I37361Medicare UPIN
RA7615Medicare ID - Type Unspecified