Provider Demographics
NPI:1962415265
Name:WOLL, JUDITH E (MD)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:E
Last Name:WOLL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:349 S. MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-2715
Mailing Address - Country:US
Mailing Address - Phone:937-461-3288
Mailing Address - Fax:937-913-3189
Practice Address - Street 1:349 S MAIN ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-2715
Practice Address - Country:US
Practice Address - Phone:937-461-3288
Practice Address - Fax:937-913-3189
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35066449207ZB0001X
IN01042246207ZB0001X
NY107922-1207ZB0001X
CAG19682207ZB0001X
ORMD20006207ZB0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine