Provider Demographics
NPI:1528008059
Name:WOLFF, JEFFREY MOYER (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:MOYER
Last Name:WOLFF
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 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9016
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:419 W PITTSBURGH ST
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-2211
Practice Address - Country:US
Practice Address - Phone:724-837-5810
Practice Address - Fax:724-837-8938
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD022361E207ND0900X, 207NI0002X, 207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological Immunology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
95930Medicare ID - Type Unspecified
PA0006578750001Medicaid
PA13331OtherKEYSTONE
PAC29795Medicare UPIN
PA95930OtherHIGHMARK
0457451OtherAETNA
PA89589OtherMEDPLUS/UNISON
PA102888OtherUPMC
CIGNAOther4512760-003