Provider Demographics
NPI:1659480309
Name:WOLFSON, ELLEN BETH (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:BETH
Last Name:WOLFSON
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 1:97 BARNES RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:WALLINGSFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492
Mailing Address - Country:US
Mailing Address - Phone:203-265-9890
Mailing Address - Fax:203-265-3321
Practice Address - Street 1:97 BARNES RD
Practice Address - Street 2:
Practice Address - City:WALLINGSFORD
Practice Address - State:CT
Practice Address - Zip Code:06492
Practice Address - Country:US
Practice Address - Phone:203-265-9890
Practice Address - Fax:203-265-3321
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT027290208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics