Healthcare Provider Details

I. General information

NPI: 1629062658
Provider Name (Legal Business Name): STEVEN JAY WOLFSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 GRAMPIAN BLVD STE 2F
WILLIAMSPORT PA
17701-1900
US

IV. Provider business mailing address

1201 GRAMPIAN BLVD STE 2F
WILLIAMSPORT PA
17701-1900
US

V. Phone/Fax

Practice location:
  • Phone: 570-323-4010
  • Fax: 570-323-4630
Mailing address:
  • Phone: 570-323-4010
  • Fax: 570-323-4630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD040912E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: