Provider Demographics
NPI:1285071233
Name:WOLF, KEVIN PAUL (DO)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:PAUL
Last Name:WOLF
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:856 J CLYDE MORRIS BLVD STE A
Mailing Address - Street 2:RIVERSIDE MEDICAL GROUP
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:757-594-4006
Mailing Address - Fax:
Practice Address - Street 1:12420 WARWICK BLVD BLDG 3
Practice Address - Street 2:RIVERSIDE INTERNAL MEDICINE
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-3001
Practice Address - Country:US
Practice Address - Phone:757-594-4431
Practice Address - Fax:757-594-2936
Is Sole Proprietor?:No
Enumeration Date:2013-05-31
Last Update Date:2024-02-25
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Provider Licenses
StateLicense IDTaxonomies
VA0102204613207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine