Provider Demographics
NPI:1770745754
Name:WOLFE, KEITH (DO)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:
Last Name:WOLFE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 802
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:PA
Mailing Address - Zip Code:16346-0802
Mailing Address - Country:US
Mailing Address - Phone:814-676-5444
Mailing Address - Fax:814-676-0342
Practice Address - Street 1:ONE PARK WAY
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:PA
Practice Address - Zip Code:16346-0802
Practice Address - Country:US
Practice Address - Phone:814-676-5444
Practice Address - Fax:814-676-0342
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS015016207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine