Healthcare Provider Details

I. General information

NPI: 1376596411
Provider Name (Legal Business Name): PATRICIA B WOLFF M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4488 FOREST PARK AVE STE 230
SAINT LOUIS MO
63108-2215
US

IV. Provider business mailing address

4488 FOREST PARK AVE STE 230
SAINT LOUIS MO
63108-2215
US

V. Phone/Fax

Practice location:
  • Phone: 314-535-7855
  • Fax: 314-534-2803
Mailing address:
  • Phone: 314-535-7855
  • Fax: 314-534-2803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR7352
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: