Provider Demographics
NPI:1255593745
Name:WOLF, FARRAH J (MD)
Entity type:Individual
Prefix:
First Name:FARRAH
Middle Name:J
Last Name:WOLF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6240 HOLLOWS LN
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-6980
Mailing Address - Country:US
Mailing Address - Phone:561-955-2680
Mailing Address - Fax:
Practice Address - Street 1:951 NW 13TH ST STE 1D
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2337
Practice Address - Country:US
Practice Address - Phone:561-447-9341
Practice Address - Fax:561-447-4316
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI150712085R0202X
RILP01364208600000X
FLME1266972085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No208600000XAllopathic & Osteopathic PhysiciansSurgery