Provider Demographics
NPI:1255711685
Name:WULF, SIOBHAN DRUMM (DO)
Entity type:Individual
Prefix:
First Name:SIOBHAN
Middle Name:DRUMM
Last Name:WULF
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SIOBHAN
Other - Middle Name:MARIE
Other - Last Name:DRUMM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:14 MEDICAL PARK, STE 400
Mailing Address - Street 2:PEDIATRIC OUTPATIENT CENTER
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203
Mailing Address - Country:US
Mailing Address - Phone:803-434-6155
Mailing Address - Fax:803-434-6979
Practice Address - Street 1:PEDIATRIC OUTPATIENT CENTER
Practice Address - Street 2:14 MEDICAL PARK, STE 400
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203
Practice Address - Country:US
Practice Address - Phone:803-434-6155
Practice Address - Fax:803-434-6979
Is Sole Proprietor?:No
Enumeration Date:2015-06-01
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL37671208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics