Provider Demographics
NPI:1649238437
Name:WOLFE, GORDON K (MD)
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:K
Last Name:WOLFE
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 1:220 CAMPUS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2896
Mailing Address - Country:US
Mailing Address - Phone:540-536-5100
Mailing Address - Fax:540-536-0235
Practice Address - Street 1:190 CAMPUS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2842
Practice Address - Country:US
Practice Address - Phone:540-536-5980
Practice Address - Fax:540-536-5979
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101042299207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006053823Medicaid
WV0071689000Medicaid
110024326OtherRAILROAD MEDICARE
B05378Medicare UPIN
VA110003756Medicare PIN
110024326Medicare PIN