1245226687 NPI number — DR. MARCIA DEBRA WOLF M.D.

Table of content: DR. MARCIA DEBRA WOLF M.D. (NPI 1245226687)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245226687 NPI number — DR. MARCIA DEBRA WOLF M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOLF
Provider First Name:
MARCIA
Provider Middle Name:
DEBRA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245226687
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/11/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4725 DORSEY HALL DR
Provider Second Line Business Mailing Address:
SUITE A903
Provider Business Mailing Address City Name:
ELLICOTT CITY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21042-7713
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-213-8812
Provider Business Mailing Address Fax Number:
443-213-8813

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19 WALKER AVE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
PIKESVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-213-8812
Provider Business Practice Location Address Fax Number:
443-213-8813
Provider Enumeration Date:
09/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  D035010 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0000X , with the licence number: D035010 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0014X , with the licence number: D035010 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2081P2900X , with the licence number: D035010 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200704500 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 277R . This is a "OLD MC" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: S1770001 . This is a "BLUE SHEILD NATIONAL CAPI" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 020046614 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0W64MD . This is a "CAREFIRST BC/BS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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