Healthcare Provider Details

I. General information

NPI: 1902282353
Provider Name (Legal Business Name): ROBERT ELLIOT WOOLF
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2015
Last Update Date: 08/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E MARKET ST
AKRON OH
44304-1619
US

IV. Provider business mailing address

559 PARKHILL DR APT 2
FAIRLAWN OH
44333-9147
US

V. Phone/Fax

Practice location:
  • Phone: 330-375-3765
  • Fax: 330-375-7586
Mailing address:
  • Phone: 330-221-3776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number367500000X
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: