Provider Demographics
NPI:1336328772
Name:WOLFFE, GLENN BARNETT (MD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:BARNETT
Last Name:WOLFFE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6338 CHURCH STREET
Mailing Address - Street 2:
Mailing Address - City:CHINCOTEAGUE
Mailing Address - State:VA
Mailing Address - Zip Code:23336
Mailing Address - Country:US
Mailing Address - Phone:757-990-1287
Mailing Address - Fax:410-912-6386
Practice Address - Street 1:6338 CHURCH STREET
Practice Address - Street 2:
Practice Address - City:CHINCOTEAGUE
Practice Address - State:VA
Practice Address - Zip Code:23336
Practice Address - Country:US
Practice Address - Phone:757-990-1287
Practice Address - Fax:757-336-2211
Is Sole Proprietor?:No
Enumeration Date:2007-11-02
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD68067207Q00000X
DEC1-0008915207Q00000X
VA0101039931207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00X848P02OtherMEDICARE
VAB05706Medicare UPIN