Provider Demographics
NPI:1902079494
Name:WOLFERT, JOHN (PA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:WOLFERT
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:541 MAIN ST
Mailing Address - Street 2:SUITE 414
Mailing Address - City:SOUTH WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-1868
Mailing Address - Country:US
Mailing Address - Phone:781-952-1433
Mailing Address - Fax:508-630-2462
Practice Address - Street 1:541 MAIN ST
Practice Address - Street 2:SUITE 414
Practice Address - City:SOUTH WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-1868
Practice Address - Country:US
Practice Address - Phone:781-952-1433
Practice Address - Fax:508-630-2462
Is Sole Proprietor?:No
Enumeration Date:2008-04-07
Last Update Date:2011-12-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MAPA4309363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant