Healthcare Provider Details

I. General information

NPI: 1245226687
Provider Name (Legal Business Name): MARCIA DEBRA WOLF M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 07/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 WALKER AVE SUITE 101
PIKESVILLE MD
21208
US

IV. Provider business mailing address

4725 DORSEY HALL DR SUITE A903
ELLICOTT CITY MD
21042-7713
US

V. Phone/Fax

Practice location:
  • Phone: 443-213-8812
  • Fax: 443-213-8813
Mailing address:
  • Phone: 443-213-8812
  • Fax: 443-213-8813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberD035010
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberD035010
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberD035010
License Number StateMD
# 4
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberD035010
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: