Provider Demographics
NPI:1902975428
Name:WOLFF, MICHAEL RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RICHARD
Last Name:WOLFF
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 1:841 HEATHER RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-6288
Mailing Address - Country:US
Mailing Address - Phone:336-229-7776
Mailing Address - Fax:336-227-4242
Practice Address - Street 1:841 HEATHER RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-6288
Practice Address - Country:US
Practice Address - Phone:336-229-7776
Practice Address - Fax:336-227-4242
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC32600208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8988822Medicaid
NC211664BOtherPSC MEDICARE PROVIDER #
NC230130OtherMEDICARE GROUP #
NCA98034Medicare UPIN
NC8988822Medicaid