Healthcare Provider Details

I. General information

NPI: 1730735259
Provider Name (Legal Business Name): LAWRENCE LOUIS WOLFGANG PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2019
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 HOWARD AVE
ALTOONA PA
16601-4810
US

IV. Provider business mailing address

1068 BEAVER DAM RD
ASHLAND PA
17921-9038
US

V. Phone/Fax

Practice location:
  • Phone: 393-081-4889
  • Fax:
Mailing address:
  • Phone: 570-985-7685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA062592
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0110011501
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA062592
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: