Provider Demographics
NPI:1619901303
Name:WOLF, ROBERT EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EDWARD
Last Name:WOLF
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 1:1857 CENTER STREET
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-1738
Mailing Address - Country:US
Mailing Address - Phone:717-763-7333
Mailing Address - Fax:717-763-7330
Practice Address - Street 1:1857 CENTER ST
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-1773
Practice Address - Country:US
Practice Address - Phone:717-763-7333
Practice Address - Fax:717-763-7330
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA044345L208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001421802004Medicaid
F39448Medicare UPIN
129583WRKMedicare PIN
129583FEGMedicare ID - Type Unspecified