Provider Demographics
NPI:1902808769
Name:WOLFLEY, LOYD A (MD)
Entity Type:Individual
Prefix:DR
First Name:LOYD
Middle Name:A
Last Name:WOLFLEY
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 1:2002 MEDICAL PKWY
Mailing Address - Street 2:SUITE 235
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3046
Mailing Address - Country:US
Mailing Address - Phone:410-266-2770
Mailing Address - Fax:410-841-6251
Practice Address - Street 1:2002 MEDICAL PKWY
Practice Address - Street 2:SUITE 235
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3046
Practice Address - Country:US
Practice Address - Phone:410-266-2770
Practice Address - Fax:410-841-6251
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00351822085R0202X
VA01010341952085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS873OtherAAD AA COUNTY
MD727COtherAAD SHIPLEYS
MD2622593OtherAETNA HMO/POS
MDA03OtherAAD PG COUNTY
MD10690015OtherBCBS
MD300031318OtherTRAVELERS RR MEDICARE
MD443321100Medicaid
MD8317071OtherAETNA PPO
MD300049091Medicare PIN
MD300031318OtherTRAVELERS RR MEDICARE
MDE25327Medicare UPIN
MD300135442Medicare PIN
MD300031318Medicare PIN
MDP00368877Medicare PIN