Provider Demographics
NPI:1407181464
Name:WOLF, JOHN KARL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:KARL
Last Name:WOLF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6804 CHASE RD
Mailing Address - Street 2:
Mailing Address - City:LA FAYETTE
Mailing Address - State:NY
Mailing Address - Zip Code:13084-9413
Mailing Address - Country:US
Mailing Address - Phone:315-683-9467
Mailing Address - Fax:
Practice Address - Street 1:6804 CHASE RD
Practice Address - Street 2:
Practice Address - City:LA FAYETTE
Practice Address - State:NY
Practice Address - Zip Code:13084-9413
Practice Address - Country:US
Practice Address - Phone:315-683-9467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-08
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1009302084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology