Provider Demographics
NPI:1750349320
Name:WOLF, C STEVEN (MD)
Entity type:Individual
Prefix:
First Name:C
Middle Name:STEVEN
Last Name:WOLF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CHARLES
Other - Middle Name:STEVEN
Other - Last Name:WOLF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:22 CARRIAGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032
Mailing Address - Country:US
Mailing Address - Phone:860-676-9036
Mailing Address - Fax:860-676-2837
Practice Address - Street 1:114 WOODLAND ST
Practice Address - Street 2:ST FRANCIS HOSPITAL & MEDICAL
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1229
Practice Address - Country:US
Practice Address - Phone:860-714-4701
Practice Address - Fax:860-714-8046
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT027706207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E14087Medicare UPIN