Provider Demographics
NPI:1760577605
Name:WOOLF, BRIAN TODD (OD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:TODD
Last Name:WOOLF
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2446 MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-1298
Mailing Address - Country:US
Mailing Address - Phone:410-255-8056
Mailing Address - Fax:410-360-8689
Practice Address - Street 1:2446 MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-1298
Practice Address - Country:US
Practice Address - Phone:410-255-8056
Practice Address - Fax:410-360-8689
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1615152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD800368800Medicaid
MDU77501Medicare UPIN
MD800368800Medicaid
MD0826100001Medicare NSC