Provider Demographics
NPI:1245226687
Name:WOLF, MARCIA DEBRA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:DEBRA
Last Name:WOLF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4725 DORSEY HALL DR
Mailing Address - Street 2:SUITE A903
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-7713
Mailing Address - Country:US
Mailing Address - Phone:443-213-8812
Mailing Address - Fax:443-213-8813
Practice Address - Street 1:19 WALKER AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208
Practice Address - Country:US
Practice Address - Phone:443-213-8812
Practice Address - Fax:443-213-8813
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD035010208100000X, 208VP0000X, 208VP0014X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD200704500Medicaid
MD277ROtherOLD MC
DCS1770001OtherBLUE SHEILD NATIONAL CAPI
020046614OtherRAILROAD MEDICARE
MD0W64MDOtherCAREFIRST BC/BS
MD277ROtherOLD MC