Provider Demographics
NPI:1508832346
Name:WOLFE, IRVING D (MD,PA)
Entity Type:Individual
Prefix:
First Name:IRVING
Middle Name:D
Last Name:WOLFE
Suffix:
Gender:M
Credentials:MD,PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 CROSSROADS DR
Mailing Address - Street 2:#255
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117
Mailing Address - Country:US
Mailing Address - Phone:410-363-2320
Mailing Address - Fax:410-363-8475
Practice Address - Street 1:21 CROSSROADS DR
Practice Address - Street 2:#255
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117
Practice Address - Country:US
Practice Address - Phone:410-363-2320
Practice Address - Fax:410-363-8475
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2010-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0013871207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD417511500Medicaid
MD9291Medicare PIN
MDAX07Medicare PIN
D74549Medicare UPIN