Provider Demographics
NPI:1104180645
Name:WOLFGANG, STEVEN L (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:L
Last Name:WOLFGANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:130 S 18TH ST
Mailing Address - Street 2:UNIT #1401
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-4923
Mailing Address - Country:US
Mailing Address - Phone:302-547-8394
Mailing Address - Fax:610-527-8434
Practice Address - Street 1:130 S 18TH ST
Practice Address - Street 2:UNIT #1401
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-4923
Practice Address - Country:US
Practice Address - Phone:302-547-8394
Practice Address - Fax:610-527-8434
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-29
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD029821L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry