Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 153261 | MA |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 153261 | MA |
NPI | 1508832767 |
---|---|
Provider Name | Dr. Charles Alexander Wolff |
First Address | Middleboro, MA 02346-2535 |
Second Address | Middleboro, MA 02346-2535 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2006 |
Last Update Date | 18/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
522239464 | TRICARE (01) | |
G87739 | (02) | MA |