Provider Demographics
NPI:1467441154
Name:WOLFF, RICHARD D (DPM)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:D
Last Name:WOLFF
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 ISAAC STREETS DR #133
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-8213
Mailing Address - Country:US
Mailing Address - Phone:419-693-0055
Mailing Address - Fax:419-693-5025
Practice Address - Street 1:1050 ISAAC STREETS DR #133
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-8213
Practice Address - Country:US
Practice Address - Phone:419-693-0055
Practice Address - Fax:419-693-5025
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.003380213E00000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2843801Medicaid
OH2560214Medicaid
OH9358241Medicare PIN
OH2560214Medicaid
OHV02677Medicare UPIN