Provider Demographics
NPI:1184751570
Name:WOLFSON, STEWART E (MD)
Entity type:Individual
Prefix:DR
First Name:STEWART
Middle Name:E
Last Name:WOLFSON
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 1:3716 HILLSDALE RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-5914
Mailing Address - Country:US
Mailing Address - Phone:502-425-7223
Mailing Address - Fax:
Practice Address - Street 1:221 S PRESTON ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1223
Practice Address - Country:US
Practice Address - Phone:502-589-1980
Practice Address - Fax:502-589-1982
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY16817207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY37000130Medicaid
KY000000054006OtherANTHEM BLUE CROSS
KY1130651OtherPASSPORT
KY4015101Medicare PIN
KY1130651OtherPASSPORT