Provider Demographics
NPI:1548561905
Name:WOLPAW, JED (MD, MED)
Entity Type:Individual
Prefix:DR
First Name:JED
Middle Name:
Last Name:WOLPAW
Suffix:
Gender:M
Credentials:MD, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 64382
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4382
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1800 ORLEANS ST
Practice Address - Street 2:ZAYED TOWER 9127 ACCM
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0010
Practice Address - Country:US
Practice Address - Phone:410-955-9080
Practice Address - Fax:410-955-8978
Is Sole Proprietor?:No
Enumeration Date:2010-11-16
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD79446207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP01689700OtherRRMC
MD093810600Medicaid
MD093810600Medicaid
MD421189Y19Medicare PIN
MD421189YUWMedicare PIN