Basic Information
| Provider Information | |||||||||
| NPI: | 1699782086 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOLF | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | SCOTT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 64697 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212644697 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103286897 | ||||||||
| FaxNumber: | 4103282109 | ||||||||
| Practice Location | |||||||||
| Address1: | 16 S EUTAW ST | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212011606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103286897 | ||||||||
| FaxNumber: | 4103282109 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2006 | ||||||||
| LastUpdateDate: | 02/04/2008 | ||||||||
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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 | 207Y00000X | D57359 | MD | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 79996 | 01 | MD | GEISINGER | OTHER | BLUE SHIELD | 01 | MD | BLUE SHIELD | OTHER | 2114168 | 01 | MD | UNITED HLTHCARE NATIONAL | OTHER | 294054 | 01 | MD | MDIPA | OTHER | 1000749 | 01 | MD | UNITED HLTHCARE | OTHER | 227408 | 01 | MD | KAISER | OTHER | 776702100 | 05 | MD | MEDICAID | 0073 | 01 | MD | CAREFIRST REGIONAL | OTHER |