Provider Demographics
NPI:1801871322
Name:WOLFE, LORNA C (DPM)
Entity type:Individual
Prefix:
First Name:LORNA
Middle Name:C
Last Name:WOLFE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 THOMAS JOHNSON DRIVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702
Mailing Address - Country:US
Mailing Address - Phone:301-695-9527
Mailing Address - Fax:301-695-0403
Practice Address - Street 1:182 THOMAS JOHNSON DRIVE
Practice Address - Street 2:SUITE 203
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702
Practice Address - Country:US
Practice Address - Phone:301-695-9527
Practice Address - Fax:301-695-0403
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01094213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD303988900Medicaid
MD134MMedicare PIN
MD303988900Medicaid
T95619Medicare UPIN
MDT95619Medicare UPIN