Provider Demographics
NPI:1891892956
Name:DOUGLAS D. WOLFE, D.O., INC.
Entity Type:Organization
Organization Name:DOUGLAS D. WOLFE, D.O., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:D
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:304-986-2996
Mailing Address - Street 1:800 E MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MANNINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:26582-1215
Mailing Address - Country:US
Mailing Address - Phone:304-986-2996
Mailing Address - Fax:304-986-2998
Practice Address - Street 1:800 E MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:MANNINGTON
Practice Address - State:WV
Practice Address - Zip Code:26582-1215
Practice Address - Country:US
Practice Address - Phone:304-986-2996
Practice Address - Fax:304-986-2998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0051821001Medicaid
WV513902Medicare ID - Type UnspecifiedRURAL HEALTH ID#
WV0051821001Medicaid