Provider Demographics
NPI:1225193972
Name:EDWARD T. WOLANSKI MD PC
Entity Type:Organization
Organization Name:EDWARD T. WOLANSKI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:T
Authorized Official - Last Name:WOLANSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:434-293-9800
Mailing Address - Street 1:600 PETER JEFFERSON PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-8837
Mailing Address - Country:US
Mailing Address - Phone:434-293-9800
Mailing Address - Fax:434-977-0088
Practice Address - Street 1:600 PETER JEFFERSON PKWY STE 300
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-8837
Practice Address - Country:US
Practice Address - Phone:434-293-9800
Practice Address - Fax:434-977-0088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101039930207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VADG6598OtherMEDICARE RAILROAD GROUP
VADG6598OtherMEDICARE RAILROAD GROUP
VAB10401Medicare UPIN