Healthcare Provider Details

I. General information

NPI: 1396764932
Provider Name (Legal Business Name): RALPH WOLF D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 W DIVISION ST SUITE F
DOVER DE
19904-2760
US

IV. Provider business mailing address

125 E MERRITT ISLAND CSWY SUITE 209 #405
MERRITT ISLAND FL
32952-3699
US

V. Phone/Fax

Practice location:
  • Phone: 302-674-3366
  • Fax: 302-674-3360
Mailing address:
  • Phone: 410-778-1933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberC2-0003033
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberH0032854
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: