Provider Demographics
NPI:1316907165
Name:WOLFE, DOUGLAS DEAN (DO)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:DEAN
Last Name:WOLFE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:800 E MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MANNINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:26582-1215
Mailing Address - Country:US
Mailing Address - Phone:304-986-2996
Mailing Address - Fax:304-986-2998
Practice Address - Street 1:800 E MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:MANNINGTON
Practice Address - State:WV
Practice Address - Zip Code:26582-1215
Practice Address - Country:US
Practice Address - Phone:304-986-2996
Practice Address - Fax:304-986-2998
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV1043207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0051821000Medicaid
WV000425042OtherBLUE CROSS
WVP01447173OtherRAILROAD
WVP01447173OtherRAILROAD
WVE19152Medicare UPIN