1780660357 NPI number — DWIGHT D WOLFE M.D.

Table of content: DWIGHT D WOLFE M.D. (NPI 1780660357)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780660357 NPI number — DWIGHT D WOLFE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOLFE
Provider First Name:
DWIGHT
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1780660357
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/24/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
676 E MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW HOLLAND
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17557-1426
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-354-4671
Provider Business Mailing Address Fax Number:
717-354-2478

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
676 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW HOLLAND
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17557-1426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-354-4671
Provider Business Practice Location Address Fax Number:
717-354-2478
Provider Enumeration Date:
12/15/2005

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: 207Q00000X , with the licence number:  MD021395E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 50043862 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 50060209 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: C31556 . This is a "HEALTH ASSURANCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 01626201 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 50068271 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 533007 . This is a "AETNA HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0007721980001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 141184 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 50061998 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 38557 S1QI . This is a "GEISINGER HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 50046252 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P002650 . This is a "GATEWAY HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 50041797 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 5535486 . This is a "AETNA NON-HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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