Provider Demographics
NPI:1164601340
Name:LORNA C. WOLFE DPM PA
Entity Type:Organization
Organization Name:LORNA C. WOLFE DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORNA
Authorized Official - Middle Name:C
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:301-695-9527
Mailing Address - Street 1:182 THOMAS JOHNSON DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4407
Mailing Address - Country:US
Mailing Address - Phone:301-695-9527
Mailing Address - Fax:301-695-0403
Practice Address - Street 1:182 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE 203
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4407
Practice Address - Country:US
Practice Address - Phone:301-695-9527
Practice Address - Fax:301-695-0403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01094213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD303988900Medicaid
4587020001Medicare NSC
MD134MMedicare PIN
MDT95619Medicare UPIN