Provider Demographics
NPI:1811332448
Name:WOLFERT, MADELINE R (MD)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:R
Last Name:WOLFERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13135 LEE JACKSON MEMORIAL HWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-1907
Mailing Address - Country:US
Mailing Address - Phone:703-391-0900
Mailing Address - Fax:
Practice Address - Street 1:13135 LEE JACKSON MEMORIAL HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1907
Practice Address - Country:US
Practice Address - Phone:703-391-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-09
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0101260152208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program