Provider Demographics
NPI:1225246150
Name:WOLFF, BRYNN SIGAL (MD)
Entity Type:Individual
Prefix:
First Name:BRYNN
Middle Name:SIGAL
Last Name:WOLFF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BRYNN
Other - Middle Name:
Other - Last Name:SIGAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:409 S 2ND ST STE 2F
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1612
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4300 LONDONDERRY ROAD
Practice Address - Street 2:SUITE 202
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109
Practice Address - Country:US
Practice Address - Phone:717-545-5000
Practice Address - Fax:717-545-5002
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD439853208600000X
PAMT181997208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102606297Medicaid