Provider Demographics
NPI:1700808029
Name:WOLFGANG, TIMOTHY C (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:C
Last Name:WOLFGANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7101 JAHNKE RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-4017
Mailing Address - Country:US
Mailing Address - Phone:804-320-2751
Mailing Address - Fax:804-673-9218
Practice Address - Street 1:7101 JAHNKE RD
Practice Address - Street 2:SUITE 500
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-4017
Practice Address - Country:US
Practice Address - Phone:804-320-2751
Practice Address - Fax:804-673-9218
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101031445208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101031445OtherMEDICAL LICENSE
VA1700808029Medicaid
VA7475772Medicaid
AW8831958OtherDEA
AW8831958OtherDEA
VAB07072Medicare UPIN
VA7475772Medicaid
P00677409Medicare PIN