Provider Demographics
NPI:1730148602
Name:WOLFE JR, GEORGE PATRICK
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:PATRICK
Last Name:WOLFE JR
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 1:754 S CLEVELAND AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:MOGADORE
Mailing Address - State:OH
Mailing Address - Zip Code:44260-2210
Mailing Address - Country:US
Mailing Address - Phone:330-877-3008
Mailing Address - Fax:330-877-2967
Practice Address - Street 1:754 S CLEVELAND AVE STE 300
Practice Address - Street 2:
Practice Address - City:MOGADORE
Practice Address - State:OH
Practice Address - Zip Code:44260-2210
Practice Address - Country:US
Practice Address - Phone:330-877-3008
Practice Address - Fax:330-877-3032
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP07411363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2442351Medicaid
OHSA9360241Medicare PIN