Provider Demographics
NPI:1194826180
Name:WOLFE, CLAGETT ANTHONY JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CLAGETT
Middle Name:ANTHONY
Last Name:WOLFE
Suffix:JR
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 1:1700 S LINCOLN AVE
Mailing Address - Street 2:LEBANON VA MEDICAL CENTER
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-7529
Mailing Address - Country:US
Mailing Address - Phone:717-272-6621
Mailing Address - Fax:717-228-6007
Practice Address - Street 1:1700 S LINCOLN AVE
Practice Address - Street 2:LEBANON VA MEDICAL CENTER
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-7529
Practice Address - Country:US
Practice Address - Phone:717-272-6621
Practice Address - Fax:717-228-6007
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD073256L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H16990Medicare UPIN