Healthcare Provider Details

I. General information

NPI: 1255406476
Provider Name (Legal Business Name): MR. MARCOS AURELIO WOLFF
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 06/25/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 FRANKLIN SQUARE DR STE 0
BALTIMORE MD
21237-3901
US

IV. Provider business mailing address

PO BOX 42684
BALTIMORE MD
21284-2684
US

V. Phone/Fax

Practice location:
  • Phone: 443-777-7138
  • Fax:
Mailing address:
  • Phone: 410-842-3017
  • Fax: 443-777-6319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberD0041255
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: