Healthcare Provider Details

I. General information

NPI: 1871695411
Provider Name (Legal Business Name): MARK EDWARD WOLPA DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2006
Last Update Date: 05/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 COLBY ST STE 104
BERKELEY CA
94705-2090
US

IV. Provider business mailing address

3000 COLBY ST STE 104
BERKELEY CA
94705-2090
US

V. Phone/Fax

Practice location:
  • Phone: 510-849-3800
  • Fax: 510-849-3810
Mailing address:
  • Phone: 510-849-3800
  • Fax: 510-849-3810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE1852
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: