Healthcare Provider Details

I. General information

NPI: 1205836079
Provider Name (Legal Business Name): MARIE C WOLFGANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 01/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CEDAR AVE
SEAFORD DE
19973-3300
US

IV. Provider business mailing address

1 CEDAR AVE
SEAFORD DE
19973-3300
US

V. Phone/Fax

Practice location:
  • Phone: 302-629-2366
  • Fax: 302-629-6570
Mailing address:
  • Phone: 302-629-2366
  • Fax: 302-629-6570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC10003884
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: