Basic Information
| Provider Information | |||||||||
| NPI: | 1023587813 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOLFE | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | PATRICK | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | CSFA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2550 MOSSIDE BLVD | ||||||||
| Address2: | 4TH FLOOR, SUITE 405 | ||||||||
| City: | MONROEVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 15146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4123731600 | ||||||||
| FaxNumber: | 4123732406 | ||||||||
| Practice Location | |||||||||
| Address1: | 2550 MOSSIDE BLVD | ||||||||
| Address2: | 4TH FLOOR, SUITE 405 | ||||||||
| City: | MONROEVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 15146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4123731600 | ||||||||
| FaxNumber: | 4123732406 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2018 | ||||||||
| LastUpdateDate: | 11/21/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246ZS0410X | Y |
No ID Information.