Provider Demographics
NPI:1508832767
Name:WOLFF, CHARLES ALEXANDER (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ALEXANDER
Last Name:WOLFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14 MCKENZIE LN
Mailing Address - Street 2:
Mailing Address - City:FOXBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02035-1151
Mailing Address - Country:US
Mailing Address - Phone:508-946-9696
Mailing Address - Fax:844-633-6168
Practice Address - Street 1:14 MCKENZIE LN
Practice Address - Street 2:
Practice Address - City:FOXBORO
Practice Address - State:MA
Practice Address - Zip Code:02035-1151
Practice Address - Country:US
Practice Address - Phone:508-946-9696
Practice Address - Fax:844-633-6168
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2023-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA153261207Q00000X, 207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
522239464OtherTRICARE
MAG87739Medicare UPIN