Provider Demographics
NPI:1376596411
Name:WOLFF, PATRICIA B (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:B
Last Name:WOLFF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4488 FOREST PARK AVE
Mailing Address - Street 2:STE 230
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-2215
Mailing Address - Country:US
Mailing Address - Phone:314-535-7855
Mailing Address - Fax:314-534-2803
Practice Address - Street 1:4488 FOREST PARK AVE
Practice Address - Street 2:STE 230
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2215
Practice Address - Country:US
Practice Address - Phone:314-535-7855
Practice Address - Fax:314-534-2803
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR7352208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
101401OtherHLINK HMO/PPO
1200179OtherUHC
39874OtherGHP
IL90000717OtherBCBS
MO26238OtherBCBS
MO2278Medicaid
MO10872289OtherCAQH
1370160OtherFIRST HEALTH
4001203OtherAETNA HMO/PPO