Provider Demographics
NPI:1285851345
Name:WOLVIN, BROOKE MARNIE (MD)
Entity Type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:MARNIE
Last Name:WOLVIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1201 SEVEN LOCKS RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20854-2931
Mailing Address - Country:US
Mailing Address - Phone:301-652-5771
Mailing Address - Fax:301-652-6332
Practice Address - Street 1:110 IRVING ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-3017
Practice Address - Country:US
Practice Address - Phone:202-877-6429
Practice Address - Fax:202-877-8626
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DCMD0375372085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC040037700Medicaid
MD040715100Medicaid
DC133546YS2Medicare PIN
MD040715100Medicaid