Provider Demographics
NPI:1851374888
Name:WOLFGANG, JILL ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:ANN
Last Name:WOLFGANG
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 1:131 POPLAR LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT WOLF
Mailing Address - State:PA
Mailing Address - Zip Code:17347-9604
Mailing Address - Country:US
Mailing Address - Phone:717-266-1995
Mailing Address - Fax:
Practice Address - Street 1:131 POPLAR LN
Practice Address - Street 2:
Practice Address - City:MOUNT WOLF
Practice Address - State:PA
Practice Address - Zip Code:17347-9604
Practice Address - Country:US
Practice Address - Phone:717-266-1995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD423474207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1536316OtherGATEWAY-YH&WMG
PA100836752Medicaid
MD641422OtherCAREFIRST MD BCBS
PA7253521OtherAETNA
PA88400OtherGEISINGER
PA1563380OtherHIGHMARK BLUE SHIELD
PA107438OtherJOHNS HOPKINS
MD641422OtherCAREFIRST MD BCBS
PA1563380OtherHIGHMARK BLUE SHIELD
H97591Medicare UPIN