Provider Demographics
NPI:1952104499
Name:WOLFE PESTANA, MARY MADISON (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:MADISON
Last Name:WOLFE PESTANA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:MADISON
Other - Last Name:WOLFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:653 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32209-6511
Mailing Address - Country:US
Mailing Address - Phone:904-244-3902
Mailing Address - Fax:904-244-3020
Practice Address - Street 1:653 W 8TH ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6511
Practice Address - Country:US
Practice Address - Phone:904-244-3902
Practice Address - Fax:904-244-3020
Is Sole Proprietor?:No
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program