Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | MD046512L | PA |
N | 2081P2900X | Pain Medicine | MD046512L | PA |
NPI | 1053304519 |
---|---|
Provider Name | Michael D. Wolk |
First Address | Scranton, PA 18508-2641 |
Second Address | Scranton, PA 18508-2641 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2005 |
Last Update Date | 24/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001280689-0002 | (05) | PA |
076698 | BLUE CARE (01) | PA |
20038440 | AMERIHEALTH (01) | PA |
22712-1067 | GEISINGER (01) | PA |
50075029 | CAPITAL BLUE CROSS (01) | PA |
534346 | AETNA (01) | PA |
719294 | BLUE CARE (01) | PA |
F27325 | (02) | PA |
P00123593 | RAILROAD MEDICARE (01) | PA |