Provider Demographics
NPI:1972560191
Name:WOLF, BETH (MD)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:
Last Name:WOLF
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 1:316 CALHOUN ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29401-1113
Mailing Address - Country:US
Mailing Address - Phone:843-724-2450
Mailing Address - Fax:
Practice Address - Street 1:2097 HENRY TECKLENBURG DR STE 201W
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5739
Practice Address - Country:US
Practice Address - Phone:843-402-1211
Practice Address - Fax:843-606-8088
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27248207RH0002X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC272485Medicaid
SCP00846425OtherRAILROAD MEDICARE ID- RSFPN
SCG648755551Medicare PIN
SCG648759223Medicare PIN
SCP00846425OtherRAILROAD MEDICARE ID- RSFPN
SC272485Medicaid