Provider Demographics
NPI:1225065733
Name:WOLF, EVAN EDWARD (RPA-C)
Entity Type:Individual
Prefix:MR
First Name:EVAN
Middle Name:EDWARD
Last Name:WOLF
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Gender:M
Credentials:RPA-C
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Mailing Address - Street 1:PO BOX 12190
Mailing Address - Street 2:PRIME CARE PHYSICIANS, PLLC
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12212-2190
Mailing Address - Country:US
Mailing Address - Phone:518-437-9840
Mailing Address - Fax:518-437-9850
Practice Address - Street 1:2 PALISADES DR
Practice Address - Street 2:AAC, A DIVISION OF PRIME CARE PHYSICIANS, PLLC
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-1438
Practice Address - Country:US
Practice Address - Phone:518-458-2000
Practice Address - Fax:518-458-1524
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2009-12-07
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Provider Licenses
StateLicense IDTaxonomies
NY011260363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEAP0641Medicare ID - Type Unspecified
Q52429Medicare UPIN