Provider Demographics
NPI:1780660357
Name:WOLFE, DWIGHT D (MD)
Entity Type:Individual
Prefix:
First Name:DWIGHT
Middle Name:D
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 1:676 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW HOLLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17557-1426
Mailing Address - Country:US
Mailing Address - Phone:717-354-4671
Mailing Address - Fax:717-354-2478
Practice Address - Street 1:676 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW HOLLAND
Practice Address - State:PA
Practice Address - Zip Code:17557-1426
Practice Address - Country:US
Practice Address - Phone:717-354-4671
Practice Address - Fax:717-354-2478
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD021395E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50043862OtherCAPITAL BLUE CROSS
PA50060209OtherCAPITAL BLUE CROSS
PAC31556OtherHEALTH ASSURANCE
PA01626201OtherCAPITAL BLUE CROSS
PA50068271OtherCAPITAL BLUE CROSS
PA533007OtherAETNA HMO
PA0007721980001Medicaid
PA141184OtherHIGHMARK BLUE SHIELD
PA50061998OtherCAPITAL BLUE CROSS
PA38557 S1QIOtherGEISINGER HEALTH PLAN
PA50046252OtherCAPITAL BLUE CROSS
PAP002650OtherGATEWAY HEALTH PLAN
PA50041797OtherCAPITAL BLUE CROSS
PA5535486OtherAETNA NON-HMO
PA50046252OtherCAPITAL BLUE CROSS
PA50061998OtherCAPITAL BLUE CROSS
PA0007721980001Medicaid
PA141184GEDMedicare PIN