Basic Information
Provider Information
NPI: 1851311153
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WOLFE
FirstName: DARIN
MiddleName: EDWARD
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 160939
Address2:  
City: ALTAMONTE SPRINGS
State: FL
PostalCode: 327160939
CountryCode: US
TelephoneNumber: 4074649516
FaxNumber: 4074649519
Practice Location
Address1: 1414 KUHL AVE
Address2:  
City: ORLANDO
State: FL
PostalCode: 32806
CountryCode: US
TelephoneNumber: 4074649516
FaxNumber: 4074649519
Other Information
ProviderEnumerationDate: 07/20/2006
LastUpdateDate: 07/05/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XME74698FLN Allopathic & Osteopathic PhysiciansInternal Medicine 
208M00000XME74698FLY Allopathic & Osteopathic PhysiciansHospitalist 

No ID Information.


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