Provider Demographics
NPI:1902282353
Name:WOOLF, ROBERT ELLIOT
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ELLIOT
Last Name:WOOLF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:559 PARKHILL DR APT 2
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-9147
Mailing Address - Country:US
Mailing Address - Phone:330-221-3776
Mailing Address - Fax:
Practice Address - Street 1:525 E MARKET ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1619
Practice Address - Country:US
Practice Address - Phone:330-375-3765
Practice Address - Fax:330-375-7586
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-08
Last Update Date:2015-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH367500000X367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered