1376596411 NPI number — DR. PATRICIA B WOLFF M.D.

Table of content: DR. PATRICIA B WOLFF M.D. (NPI 1376596411)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376596411 NPI number — DR. PATRICIA B WOLFF M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOLFF
Provider First Name:
PATRICIA
Provider Middle Name:
B
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:
1376596411
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4488 FOREST PARK AVE
Provider Second Line Business Mailing Address:
STE 230
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63108-2215
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-535-7855
Provider Business Mailing Address Fax Number:
314-534-2803

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4488 FOREST PARK AVE
Provider Second Line Business Practice Location Address:
STE 230
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63108-2215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-535-7855
Provider Business Practice Location Address Fax Number:
314-534-2803
Provider Enumeration Date:
05/18/2006

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: 208000000X , with the licence number:  R7352 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 101401 . This is a "HLINK HMO/PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1200179 . This is a "UHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 39874 . This is a "GHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 90000717 . This is a "BCBS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 26238 . This is a "BCBS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 2278 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10872289 . This is a "CAQH" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1370160 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4001203 . This is a "AETNA HMO/PPO" identifier . This identifiers is of the category "OTHER".




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