Provider Demographics
NPI:1629178470
Name:ROBERT N WOLFE MD AND ANDREW S WACHTEL MD A PARTNER OF PROF
Entity Type:Organization
Organization Name:ROBERT N WOLFE MD AND ANDREW S WACHTEL MD A PARTNER OF PROF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:NORTON
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-657-3792
Mailing Address - Street 1:8635 W 3RD ST
Mailing Address - Street 2:SUITE 965W
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-6106
Mailing Address - Country:US
Mailing Address - Phone:310-657-3792
Mailing Address - Fax:310-657-3799
Practice Address - Street 1:8635 W 3RD ST
Practice Address - Street 2:SUITE 965W
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-6106
Practice Address - Country:US
Practice Address - Phone:310-657-3792
Practice Address - Fax:310-657-3799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG32286207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0056470Medicaid
CAGR0056470Medicaid