Provider Demographics
NPI:1578589354
Name:WOLK, STEPHEN M (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:M
Last Name:WOLK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:700 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18201-6835
Mailing Address - Country:US
Mailing Address - Phone:570-288-8881
Mailing Address - Fax:570-288-8065
Practice Address - Street 1:50 MOISEY DRIVE SUITE 103
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18202
Practice Address - Country:US
Practice Address - Phone:570-501-6580
Practice Address - Fax:570-501-6598
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2019-08-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD038358L207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009196560001Medicaid
PA0009196560001Medicaid
PA433095VNBMedicare PIN