Provider Demographics
NPI:1023037397
Name:WOLF, RAYMOND D (DO,RVT,RPVI)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:D
Last Name:WOLF
Suffix:
Gender:M
Credentials:DO,RVT,RPVI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MARTY LN
Mailing Address - Street 2:
Mailing Address - City:WEST ALEXANDRIA
Mailing Address - State:OH
Mailing Address - Zip Code:45381-1165
Mailing Address - Country:US
Mailing Address - Phone:937-839-4681
Mailing Address - Fax:937-839-1126
Practice Address - Street 1:1 MARTY LN
Practice Address - Street 2:
Practice Address - City:WEST ALEXANDRIA
Practice Address - State:OH
Practice Address - Zip Code:45381-1165
Practice Address - Country:US
Practice Address - Phone:937-839-4681
Practice Address - Fax:937-839-1126
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-4358W207Q00000X
OH4358202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHD97899Medicare UPIN