Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD8535 | RI |
N | 207QA0401X | Family Doctor - Addiction Medicine | MD8535 | RI |
NPI | 1841358587 |
---|---|
Provider Name | Ivan S. Wolfson |
First Address | Providence, RI 02905-5010 |
Second Address | Providence, RI 02905-5010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2006 |
Last Update Date | 26/04/2021 |