Provider Demographics
NPI:1154311157
Name:WOLF, DAVID M (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:WOLF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:55 SPINDRIFT DR
Mailing Address - Street 2:WINDSONG RADIOLOGY GROUP, P.C.
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7800
Mailing Address - Country:US
Mailing Address - Phone:716-631-2500
Mailing Address - Fax:716-631-1249
Practice Address - Street 1:55 SPINDRIFT DR
Practice Address - Street 2:WINDSONG RADIOLOGY GROUP, P.C.
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-7800
Practice Address - Country:US
Practice Address - Phone:716-631-2500
Practice Address - Fax:716-631-1249
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1698342085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0109715OtherGHI
NY01200251Medicaid
NY00027588701OtherUNIVERA
NY01200251OtherBCBS OF WNY
NYRB0454OtherMEDICARE
NY060718000031OtherFIEDLIS
NY16-13200OtherIHA
NY16-13200OtherIHA