Provider Demographics
NPI:1912985094
Name:WOLFE, JAMES R (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:WOLFE
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 1:605 S TRIMBLE RD
Mailing Address - Street 2:STE B
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906-4112
Mailing Address - Country:US
Mailing Address - Phone:419-709-8270
Mailing Address - Fax:419-709-8275
Practice Address - Street 1:605 S TRIMBLE RD
Practice Address - Street 2:STE B
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-4112
Practice Address - Country:US
Practice Address - Phone:419-709-8270
Practice Address - Fax:419-709-8275
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35062677W207LP2900X
OH35062677208VP0014X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0118670Medicaid
G00636Medicare UPIN
OH0779809Medicare ID - Type Unspecified
OH0118670Medicaid