Provider Demographics
NPI:1386954790
Name:IRVING D. WOLFE, M.D.,PA
Entity type:Organization
Organization Name:IRVING D. WOLFE, M.D.,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IRVING
Authorized Official - Middle Name:D
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-363-2320
Mailing Address - Street 1:21 CROSSROADS DRIVE
Mailing Address - Street 2:#255
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117
Mailing Address - Country:US
Mailing Address - Phone:410-363-2320
Mailing Address - Fax:410-363-8475
Practice Address - Street 1:21 CROSSROADS DRIVE
Practice Address - Street 2:#255
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117
Practice Address - Country:US
Practice Address - Phone:410-363-2320
Practice Address - Fax:410-363-8475
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IRVING D. WOLFE, MD, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-19
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD417511500Medicaid
MD417511500Medicaid
MD9291Medicare PIN