MEDICARE: DR. SANFORD MAYER WOLFE DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RR0500X	Rheumatology Physician	OH34002602	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	010015697	OTHER	GA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000012368	OTHER	OH	ANTHEM BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	3220007	OTHER	OH	UNITED HEALTHCARE
5	1123456789000	OTHER		MEDICAL MUTUAL

General Provider Information

NPI Number	:	1255390233
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANFORD MAYER WOLFE DO

Provider Business Mailing Address
First Line	:	3170 KETTERING BLVD BLDG B3
Second Line	:
City	:	MORAINE
State	:	OH
Zip	:	45439-1924
Country	:	US
Telephone Number	:	937-991-3188
Fax Number	:	991-223-9811

Provider Business Practice Location Address
First Line	:	1 ELIZABETH PL
Second Line	:	STE 230
City	:	DAYTON
State	:	OH
Zip	:	45417-3445
Country	:	US
Telephone Number	:	937-223-4900
Fax Number	:	937-223-4420

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2006
Last Update Date	:	01/08/2019

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Directions to “ DR. SANFORD MAYER WOLFE DO” Practice Location

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