Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 030531 | CT |
NPI | 1023016185 |
---|---|
Provider Name | Mark Wolf |
First Address | Hartford, CT 06105-1770 |
Second Address | Hartford, CT 06105-1770 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2005 |
Last Update Date | 20/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001305318 | (05) | CT |
E37723 | (02) | CT |