Provider Demographics
NPI:1396764932
Name:WOLF, RALPH (DO)
Entity type:Individual
Prefix:
First Name:RALPH
Middle Name:
Last Name:WOLF
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 E MERRITT ISLAND CSWY
Mailing Address - Street 2:SUITE 209 #405
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-3699
Mailing Address - Country:US
Mailing Address - Phone:410-778-1933
Mailing Address - Fax:
Practice Address - Street 1:630 W DIVISION ST
Practice Address - Street 2:SUITE F
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-2760
Practice Address - Country:US
Practice Address - Phone:302-674-3366
Practice Address - Fax:302-674-3360
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC2-00030332084F0202X
MDH00328542084F0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD609550002Medicaid
DED00343OtherCONTROLLED SUBSTANCE LICE
FL262456700Medicaid
MDH0032854OtherDHMH
MD609550001Medicaid
FLOS 8277OtherST OF FL DEPT OF HEALTH L
MD609550004Medicaid
DEC2-0003033OtherPHYSICIAN LICENSE
MD609550004Medicaid
DEC2-0003033OtherPHYSICIAN LICENSE
DED00343OtherCONTROLLED SUBSTANCE LICE
DEC2-0003033OtherPHYSICIAN LICENSE