Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0214X | Pediatric Pulmonologist | 35.096946 | OH |
NPI | 1235447939 |
---|---|
Provider Name | Stephen J Wolf |
First Address | Dayton, OH 45404-1815 |
Second Address | Dayton, OH 45404-1815 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2010 |
Last Update Date | 27/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0051945 | (05) | OH |
H618881 | MEDICARE PTAN - DCSP (01) |