Provider Demographics
NPI:1528051745
Name:WOLFE, KENNETH H (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:H
Last Name:WOLFE
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 1:100 W 6TH ST
Mailing Address - Street 2:STE 5
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-2428
Mailing Address - Country:US
Mailing Address - Phone:610-566-8342
Mailing Address - Fax:610-891-8566
Practice Address - Street 1:100 W 6TH ST
Practice Address - Street 2:STE 5
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-2428
Practice Address - Country:US
Practice Address - Phone:610-566-8342
Practice Address - Fax:610-891-8566
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD042402L207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
459882OtherAETNA/USH
459882OtherAETNA/USH
F42890Medicare UPIN