Provider Demographics
NPI:1255337168
Name:WOLFE, DAVID L (PA-C)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:WOLFE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:785 5TH AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4232
Mailing Address - Country:US
Mailing Address - Phone:717-263-9555
Mailing Address - Fax:717-709-6529
Practice Address - Street 1:120 N 7TH ST STE 200
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-1795
Practice Address - Country:US
Practice Address - Phone:717-217-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA002200L363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00841791OtherRAILROAD MEDICARE
PA25-1716306OtherINFORMED
PA9436544OtherAETNA NON HMO
PA50119323OtherCAPITAL BLUE CROSS
PA6382314OtherAETNA HMO
PA120420423OtherDEPT OF LABOR
PA1255337168OtherHEALTH AMERICA
PA25-1716306OtherDEVON
PA25-1716306OtherFIRST HEALTH
PA867633OtherMEDICARE GROUP #
PA103181790Medicaid
PA25-1716306OtherTRICARE
PA25-1716306OtherINTERGROUP
PA25-1716306OtherPHCS/MULTI PLAN
PA50072051OtherCAPITAL BLUE CROSS
PAMA002200LOtherLICENSE
PAMA002200LOtherLICENSE
PAWO005112Medicare ID - Type Unspecified
PA171973LN7Medicare PIN
PA25-1716306OtherPHCS/MULTI PLAN