Provider Demographics
NPI:1174521355
Name:WOLFMAN, MARC RAFAEL (MD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:RAFAEL
Last Name:WOLFMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:205 MAY ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-3267
Mailing Address - Country:US
Mailing Address - Phone:732-661-9225
Mailing Address - Fax:732-661-9259
Practice Address - Street 1:205 MAY ST
Practice Address - Street 2:SUITE 201
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-3267
Practice Address - Country:US
Practice Address - Phone:732-661-9225
Practice Address - Fax:732-661-9259
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2022-05-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJMA33634207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0991601Medicaid
NJ0991601Medicaid
NJ043074Medicare ID - Type Unspecified