Provider Demographics
NPI:1861431561
Name:WOLFF, GREGG (MD)
Entity type:Individual
Prefix:MR
First Name:GREGG
Middle Name:
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 1:805 OLDTOWN ROAD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-4053
Mailing Address - Country:US
Mailing Address - Phone:240-410-0401
Mailing Address - Fax:240-362-7173
Practice Address - Street 1:805 OLDTOWN ROAD
Practice Address - Street 2:SUITE B
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-4053
Practice Address - Country:US
Practice Address - Phone:240-410-0401
Practice Address - Fax:240-362-7173
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH19766207X00000X
MDD0048127207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD8501441P0000Medicaid
173207ZFT6OtherPTAN
MD850144100Medicaid
MDG16112Medicare UPIN