Provider Demographics
NPI:1841240108
Name:WOLOKOLIE, TEIZU (MD)
Entity Type:Individual
Prefix:DR
First Name:TEIZU
Middle Name:
Last Name:WOLOKOLIE
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 1:9715 HEALTHWAY DR
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-3500
Mailing Address - Country:US
Mailing Address - Phone:443-548-5700
Mailing Address - Fax:443-548-5705
Practice Address - Street 1:9715 HEALTHWAY DR
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-3500
Practice Address - Country:US
Practice Address - Phone:443-548-5700
Practice Address - Fax:443-548-5705
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32195207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ825838-01Medicaid
AZ825838-01Medicaid
AZH98913Medicare UPIN