Provider Demographics
NPI:1174502934
Name:WOLFE, JAMES T (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:T
Last Name:WOLFE
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:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0909
Mailing Address - Country:US
Mailing Address - Phone:502-588-0325
Mailing Address - Fax:
Practice Address - Street 1:550 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1622
Practice Address - Country:US
Practice Address - Phone:502-521-8168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA99006207ZP0102X
OH35074920207ZP0102X
ORMD156484207ZP0102X
KY45600207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200225570CMedicaid
KY64962434Medicaid
OH000000035571OtherBLUE CROSS BLUE SHIELD
IN200225570AMedicaid
220024577OtherRAILROAD MEDICARE
IN200225570DMedicaid
IN200225570EMedicaid
IN200225570FMedicaid
OH2093943Medicaid
OHWO0860074Medicare ID - Type Unspecified
OH2093943Medicaid
D83737Medicare UPIN
OHWO0860073Medicare ID - Type Unspecified
ORR163480Medicare PIN
KY64962434Medicaid