Healthcare Provider Details

I. General information

NPI: 1396830659
Provider Name (Legal Business Name): ELIZABETH WOLFE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 09/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 ALLEN STREET
HANOVER NH
03755
US

IV. Provider business mailing address

7 ALLEN STREET
HANOVER NH
03755-1000
US

V. Phone/Fax

Practice location:
  • Phone: 603-738-1164
  • Fax:
Mailing address:
  • Phone: 603-738-1164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number12044
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: