Provider Demographics
NPI:1639660558
Name:WOLFGANG, TAYLOR CHARLOTTE (MD)
Entity Type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:CHARLOTTE
Last Name:WOLFGANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 BEACON ST APT 703
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-2228
Mailing Address - Country:US
Mailing Address - Phone:802-793-2865
Mailing Address - Fax:
Practice Address - Street 1:755 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1520
Practice Address - Country:US
Practice Address - Phone:617-636-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-26
Last Update Date:2018-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA275600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine