Provider Demographics
NPI:1306233911
Name:WOLF, JOEL ANDREW (MD)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:ANDREW
Last Name:WOLF
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 1:127 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-3016
Mailing Address - Country:US
Mailing Address - Phone:347-543-9068
Mailing Address - Fax:
Practice Address - Street 1:127 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-3016
Practice Address - Country:US
Practice Address - Phone:347-543-9068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-21
Last Update Date:2024-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3043682085R0204X
PAMD4768442085R0204X
FLME1454912085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology