1396764932 NPI number — RALPH WOLF D.O.

Table of content: RALPH WOLF D.O. (NPI 1396764932)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396764932 NPI number — RALPH WOLF D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOLF
Provider First Name:
RALPH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

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:
1396764932
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
125 E MERRITT ISLAND CSWY
Provider Second Line Business Mailing Address:
SUITE 209 #405
Provider Business Mailing Address City Name:
MERRITT ISLAND
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32952-3699
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-778-1933
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
630 W DIVISION ST
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
DOVER
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19904-2760
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-674-3366
Provider Business Practice Location Address Fax Number:
302-674-3360
Provider Enumeration Date:
07/18/2006

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: 2084F0202X , with the licence number:  C2-0003033 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084F0202X , with the licence number: H0032854 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 609550002 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: D00343 . This is a "CONTROLLED SUBSTANCE LICE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 262456700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: H0032854 . This is a "DHMH" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 609550001 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: OS 8277 . This is a "ST OF FL DEPT OF HEALTH L" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 609550004 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: C2-0003033 . This is a "PHYSICIAN LICENSE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 111182000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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