Provider Demographics
NPI:1326281247
Name:WOLO, ELIZABETH THERESA (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:THERESA
Last Name:WOLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E OLNEY AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-2470
Mailing Address - Country:US
Mailing Address - Phone:215-456-1825
Mailing Address - Fax:215-456-5926
Practice Address - Street 1:559 W GERMANTOWN PIKE
Practice Address - Street 2:
Practice Address - City:EAST NORRITON
Practice Address - State:PA
Practice Address - Zip Code:19403-4250
Practice Address - Country:US
Practice Address - Phone:484-622-1248
Practice Address - Fax:484-622-1269
Is Sole Proprietor?:No
Enumeration Date:2009-04-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT195106207L00000X
PAMD448911207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0366081Medicaid
PA102850410 0001Medicaid
PAMT195106OtherMEDICAL TRAINING LICENSE
PAMD448911OtherUNRESCTRICTED
PA102850410000Medicaid
PA102850410000Medicaid