Provider Demographics
NPI:1740861830
Name:WOLFF, NICHOLAS HUNTER MARK (MD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:HUNTER MARK
Last Name:WOLFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:NICK
Other - Middle Name:HUNTER MARK
Other - Last Name:WOLFF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3935 CLIPPERS RD
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-3804
Mailing Address - Country:US
Mailing Address - Phone:651-260-6520
Mailing Address - Fax:
Practice Address - Street 1:600 ROE AVE
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14905-1629
Practice Address - Country:US
Practice Address - Phone:607-737-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-20
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0073093207P00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program