Provider Demographics
NPI:1861402828
Name:WOLF, STEVEN U (DO)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:U
Last Name:WOLF
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:9331 OLD BUSTLETON AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-4204
Mailing Address - Country:US
Mailing Address - Phone:215-673-7070
Mailing Address - Fax:215-673-2828
Practice Address - Street 1:9331 OLD BUSTLETON AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-4204
Practice Address - Country:US
Practice Address - Phone:215-673-7070
Practice Address - Fax:215-673-2828
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS009131L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACD4829OtherTPI GROUP RAILROAD MEDICARE
PA1007278000OtherTPI GROUP MEDICAID ID
PA0017390260001Medicaid
0706166000OtherIBC
PA597586OtherTPI MEDICARE GROUP ID
0706166000OtherIBC
009476E42Medicare ID - Type Unspecified