Healthcare Provider Details

I. General information

NPI: 1114056090
Provider Name (Legal Business Name): SANFORD M WOLFE DO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 05/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W 1ST ST STE 544
DAYTON OH
45402-1154
US

IV. Provider business mailing address

111 W 1ST ST STE 544
DAYTON OH
45402-1154
US

V. Phone/Fax

Practice location:
  • Phone: 937-223-4900
  • Fax: 937-223-4420
Mailing address:
  • Phone: 937-223-4900
  • Fax: 937-223-4420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: BARBARA A SINK
Title or Position: BILLING MANAGER
Credential:
Phone: 937-223-4900