Provider Demographics
NPI:1649357492
Name:WOLFSDORF, JOSEPH I (MB, BCH)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:I
Last Name:WOLFSDORF
Suffix:
Gender:M
Credentials:MB, BCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 LONGWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5724
Mailing Address - Country:US
Mailing Address - Phone:617-355-7476
Mailing Address - Fax:617-730-0194
Practice Address - Street 1:333 LONGWOOD AVE
Practice Address - Street 2:FLOOR 6
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5711
Practice Address - Country:US
Practice Address - Phone:617-355-7477
Practice Address - Fax:617-730-0194
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA40744208000000X, 2080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2082180Medicaid
D82818Medicare UPIN
E05103Medicare ID - Type Unspecified