Basic Information
| Provider Information | |||||||||
| NPI: | 1750381984 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOLFF | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 307 S FRONT ST | ||||||||
| Address2: | 1ST FLOOR | ||||||||
| City: | HARRISBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 171041621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172318540 | ||||||||
| FaxNumber: | 7172318588 | ||||||||
| Practice Location | |||||||||
| Address1: | 1025 W HARRISBURG PIKE | ||||||||
| Address2: | |||||||||
| City: | MIDDLETOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170574848 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7179440491 | ||||||||
| FaxNumber: | 7179441436 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2005 | ||||||||
| LastUpdateDate: | 07/30/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 211874 | NY | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD449428 | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 102877093 | 05 | PA | MEDICAID |