Provider Demographics
NPI:1144286238
Name:WOLD, STEPHEN M (MD)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:M
Last Name:WOLD
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 1:2011 PINTO LANE
Mailing Address - Street 2:#200
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106
Mailing Address - Country:US
Mailing Address - Phone:702-382-3200
Mailing Address - Fax:702-382-3575
Practice Address - Street 1:2011 PINTO LANE
Practice Address - Street 2:#200
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106
Practice Address - Country:US
Practice Address - Phone:702-382-3200
Practice Address - Fax:702-382-3575
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8690207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2018058Medicaid
36162Medicare ID - Type Unspecified
NV2018058Medicaid