Provider Demographics
NPI:1992765481
Name:WOLFBERG, ADAM JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:JOHN
Last Name:WOLFBERG
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 1:1 BLACKSTONE ST APT 2
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-3881
Mailing Address - Country:US
Mailing Address - Phone:617-699-1022
Mailing Address - Fax:
Practice Address - Street 1:11500 UNIVERSITY BLVD STE B
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-2197
Practice Address - Country:US
Practice Address - Phone:407-246-1788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME158977207V00000X
MA224104207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA442003OtherCIGNA PPO/EPO
MA470483OtherTUFTS HEALTH PLAN
MA130142OtherHARVARD PILGRIM
MA224104-J29214OtherBLUE CARE ELECT
MA2105268Medicaid
MA5610844OtherCIGNA HMO/POS
MA7877755OtherAETNA
MAJ29214OtherBLUE CROSS BLUE SHIELD
MAI30142Medicare UPIN
MAA38387Medicare ID - Type UnspecifiedMEDICARE