Provider Demographics
NPI:1023414455
Name:WULFF, THOMAS JR (PA-C)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:WULFF
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 22958
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44122-0958
Mailing Address - Country:US
Mailing Address - Phone:216-595-9600
Mailing Address - Fax:216-595-9601
Practice Address - Street 1:7215 OLD OAK BLVD
Practice Address - Street 2:STE A-311
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44130-3340
Practice Address - Country:US
Practice Address - Phone:440-891-8880
Practice Address - Fax:440-891-8884
Is Sole Proprietor?:No
Enumeration Date:2014-11-12
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.004208363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant