1851374888 NPI number — DR. JILL ANN WOLFGANG M.D.

Table of content: WALTER BRACKEN CRNA (NPI 1801865712)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851374888 NPI number — DR. JILL ANN WOLFGANG M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOLFGANG
Provider First Name:
JILL
Provider Middle Name:
ANN
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:
1851374888
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
131 POPLAR LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT WOLF
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17347-9604
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-266-1995
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
131 POPLAR LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT WOLF
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17347-9604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-266-1995
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/23/2005

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: 207RI0200X , with the licence number:  MD423474 , 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: 1536316 . This is a "GATEWAY-YH&WMG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 100836752 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 641422 . This is a "CAREFIRST MD BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 7253521 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 88400 . This is a "GEISINGER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1563380 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 107438 . This is a "JOHNS HOPKINS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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