Healthcare Provider Details

I. General information

NPI: 1548766850
Provider Name (Legal Business Name): MATTHEW MARK WOLBERT DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2018
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9605 JEFFERSON HWY STE E
RIVER RIDGE LA
70123-2550
US

IV. Provider business mailing address

1100 POYDRAS ST 2500 ENERGY CENTER
NEW ORLEANS LA
70163-2500
US

V. Phone/Fax

Practice location:
  • Phone: 504-738-1600
  • Fax: 504-737-1264
Mailing address:
  • Phone: 45-527-9953
  • Fax: 45-527-9950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS020546
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number345835
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: