Provider Demographics
NPI:1699777037
Name:WOLFE, WARREN (DO)
Entity type:Individual
Prefix:DR
First Name:WARREN
Middle Name:
Last Name:WOLFE
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 1:10501 CHATHAM RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:SPOTSYLVANIA
Mailing Address - State:VA
Mailing Address - Zip Code:22553-8911
Mailing Address - Country:US
Mailing Address - Phone:856-625-9461
Mailing Address - Fax:540-972-4436
Practice Address - Street 1:10620 SPOTSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-2637
Practice Address - Country:US
Practice Address - Phone:540-710-1086
Practice Address - Fax:540-710-1126
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102201461207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006749W86Medicare ID - Type Unspecified
D80311Medicare UPIN