Provider Demographics
NPI:1881678324
Name:WOOLFOLK, GREGORY M (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:M
Last Name:WOOLFOLK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1169 EASTERN PKWY
Mailing Address - Street 2:G58
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40217
Mailing Address - Country:US
Mailing Address - Phone:502-452-9567
Mailing Address - Fax:502-473-0586
Practice Address - Street 1:1720 NICHOLASVILLE RD STE 302
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1457
Practice Address - Country:US
Practice Address - Phone:859-276-4382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY30826207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1136278OtherPASSPORT
KY64308265Medicaid
KY64308265Medicaid
KY1906701Medicare ID - Type Unspecified