Healthcare Provider Details

I. General information

NPI: 1366502759
Provider Name (Legal Business Name): LAUREN JACKLYN WOLF MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 08/28/2020
Certification Date: 08/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 WISCONSIN AVE
BETHESDA MD
20889-5000
US

IV. Provider business mailing address

7700 ARLINGTON BLVD
FALLS CHURCH VA
22042-2929
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-4000
  • Fax:
Mailing address:
  • Phone: 703-681-7176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101237935
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: