Healthcare Provider Details

I. General information

NPI: 1417280165
Provider Name (Legal Business Name): STEPHEN PAUL WOLF PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2009
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33672 BAYVIEW MEDICAL DR FL 1
LEWES DE
19958-1687
US

IV. Provider business mailing address

1515 SAVANNAH RD
LEWES DE
19958-1675
US

V. Phone/Fax

Practice location:
  • Phone: 302-703-3630
  • Fax: 302-645-8473
Mailing address:
  • Phone: 302-313-2298
  • Fax: 302-645-3691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberC5-0011502
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: