Provider Demographics
NPI:1073677415
Name:WOLF, JAMES S (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:S
Last Name:WOLF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6565 N CHARLES ST STE 415
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204-5803
Mailing Address - Country:US
Mailing Address - Phone:410-821-7939
Mailing Address - Fax:
Practice Address - Street 1:6565 N CHARLES ST STE 415
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-5803
Practice Address - Country:US
Practice Address - Phone:410-821-7939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD271122084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDK866JAOtherCAREFIRST MARYLAND
MDF2240001OtherCAREFIRST REGIONAL
MDS1430004OtherCAREFIRST REGIONAL
MD2140902OtherUHC MAMSI ALLIANCE OPT CH
MDKJ32351017-05OtherCAREFIRST MARYLAND
MDK866Medicare PIN
MDD76388Medicare UPIN
MD676LJ372Medicare PIN