Provider Demographics
NPI:1811936537
Name:WOLKOFF, LAWRENCE H (MD)
Entity type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:H
Last Name:WOLKOFF
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 1:9500 MENTOR AVE
Mailing Address - Street 2:STE 370
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-5796
Mailing Address - Country:US
Mailing Address - Phone:440-946-4555
Mailing Address - Fax:440-357-5353
Practice Address - Street 1:9500 MENTOR AVE
Practice Address - Street 2:STE 370
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-5796
Practice Address - Country:US
Practice Address - Phone:440-946-4555
Practice Address - Fax:440-357-5353
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35049563W208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000133826OtherANTHEM
OH0738054Medicaid
OH50607OtherQUALCHOICE
340018529OtherRAILROAD MEDICARE
1900658OtherUNITED HEALTH CARE
05112OtherKAISER
238986OtherAETNA
E29838Medicare UPIN
OHW00645176Medicare ID - Type Unspecified