Provider Demographics
NPI:1255390233
Name:WOLFE, SANFORD MAYER (DO)
Entity type:Individual
Prefix:DR
First Name:SANFORD
Middle Name:MAYER
Last Name:WOLFE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3170 KETTERING BLVD BLDG B3
Mailing Address - Street 2:
Mailing Address - City:MORAINE
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1924
Mailing Address - Country:US
Mailing Address - Phone:937-991-3188
Mailing Address - Fax:991-223-9811
Practice Address - Street 1:1 ELIZABETH PL
Practice Address - Street 2:STE 230
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-3445
Practice Address - Country:US
Practice Address - Phone:937-223-4900
Practice Address - Fax:937-223-4420
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH34002602207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000012368OtherANTHEM BCBS
OH0634700Medicaid
OH3220007OtherUNITED HEALTHCARE
GA010015697OtherRAILROAD MEDICARE
1123456789000OtherMEDICAL MUTUAL
OH0588375Medicare ID - Type Unspecified
OH0634700Medicaid