Provider Demographics
NPI:1669455812
Name:WOLF, THOMAS JASON (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:JASON
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 1:63 HEALTHCARE DR
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-5120
Mailing Address - Country:US
Mailing Address - Phone:828-586-7796
Mailing Address - Fax:828-586-7810
Practice Address - Street 1:63 HEALTHCARE DR
Practice Address - Street 2:
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-5120
Practice Address - Country:US
Practice Address - Phone:828-586-7796
Practice Address - Fax:828-586-7810
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2002-01544207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891320RMedicaid
NCNCU828BOtherMEDICARE
NC1320ROtherBCBS NC
NCP02379366OtherRAILROAD MEDICARE