Provider Demographics
NPI:1386664944
Name:WOLD, ERIC (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:WOLD
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 1:100 WOODS RD
Mailing Address - Street 2:TCC-D342
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595-1530
Mailing Address - Country:US
Mailing Address - Phone:914-493-6616
Mailing Address - Fax:914-493-5127
Practice Address - Street 1:100 WOODS RD
Practice Address - Street 2:TCC-D342
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1530
Practice Address - Country:US
Practice Address - Phone:914-493-6616
Practice Address - Fax:914-493-5127
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY212926207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY110244758OtherRAILROAD MEDICARE
NY1439190OtherAETNA HMO
NYWE2926OtherATLANTIS HEALTH PLAN
NY696152OtherMVP
NY00000071005OtherGHI HMO
NY01974827Medicaid
NY505691OtherEMPIRE BCBS (VALHALLA)
NY5502773OtherAETNA PPO
NYP2640191OtherOXFORD
NY1724225OtherFIRST HEALTH
NY4C3135OtherHEALTHNET
NY2590442OtherGHI PPO
NY110244758OtherRAILROAD MEDICARE