Provider Demographics
NPI:1073519336
Name:WOLF, ANDREAS (MD)
Entity type:Individual
Prefix:
First Name:ANDREAS
Middle Name:
Last Name:WOLF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 GOODWIN CT
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94061-2470
Mailing Address - Country:US
Mailing Address - Phone:609-439-6385
Mailing Address - Fax:
Practice Address - Street 1:900 GREENLEY RD STE 911
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5287
Practice Address - Country:US
Practice Address - Phone:209-536-3249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51954207RI0011X
NJ25MA07802900207RI0011X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3823193OtherAETNA HMO #
NJP2797586OtherOXFORD ID #
NJ7193107OtherAETNA PPO #
NJP2797586OtherOXFORD ID #
462009036OtherTIN
462009036OtherTIN
NJG86411Medicare UPIN
NJ7193107OtherAETNA PPO #