Basic Information
| Provider Information | |||||||||
| NPI: | 1336328772 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOLFFE | ||||||||
| FirstName: | GLENN | ||||||||
| MiddleName: | BARNETT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6338 CHURCH STREET | ||||||||
| Address2: | |||||||||
| City: | CHINCOTEAGUE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 23336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7579901287 | ||||||||
| FaxNumber: | 4109126386 | ||||||||
| Practice Location | |||||||||
| Address1: | 6338 CHURCH STREET | ||||||||
| Address2: | |||||||||
| City: | CHINCOTEAGUE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 23336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7579901287 | ||||||||
| FaxNumber: | 7573362211 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2007 | ||||||||
| LastUpdateDate: | 06/19/2018 | ||||||||
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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 | 207Q00000X | D68067 | MD | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | C1-0008915 | DE | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 0101039931 | VA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00X848P02 | 01 | VA | MEDICARE | OTHER |