Provider Demographics
NPI:1164694485
Name:LLOYD M.WOLF III D.O. INTERNAL MEDICINE, PC
Entity Type:Organization
Organization Name:LLOYD M.WOLF III D.O. INTERNAL MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LLOYD
Authorized Official - Middle Name:M
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:III
Authorized Official - Credentials:DO
Authorized Official - Phone:610-743-3139
Mailing Address - Street 1:2 MERIDIAN BLVD
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-3202
Mailing Address - Country:US
Mailing Address - Phone:610-743-3139
Mailing Address - Fax:610-743-3143
Practice Address - Street 1:2 MERIDIAN BLVD
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-3202
Practice Address - Country:US
Practice Address - Phone:610-743-3139
Practice Address - Fax:610-743-3143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012325261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care