Provider Demographics
NPI:1316074735
Name:WOLFE, HIATT T (PA-C)
Entity type:Individual
Prefix:
First Name:HIATT
Middle Name:T
Last Name:WOLFE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:HIATT
Other - Middle Name:G
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:401 MATTHEW ST
Mailing Address - Street 2:EMERGENCY DEPARTMENT
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:800 PIKE ST STE 2
Practice Address - Street 2:EXPRESS CARE - MARIETTA
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-3507
Practice Address - Country:US
Practice Address - Phone:740-373-3960
Practice Address - Fax:740-373-3965
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV01281363AM0700X
NY010956363AM0700X
OH50.003091RX363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0084465Medicaid
WVPA36201Medicare PIN
OH0084465Medicaid
OHPA36202Medicare PIN
SCQ31058Medicare UPIN