Healthcare Provider Details

I. General information

NPI: 1336328772
Provider Name (Legal Business Name): GLENN BARNETT WOLFFE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2007
Last Update Date: 06/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6338 CHURCH STREET
CHINCOTEAGUE VA
23336
US

IV. Provider business mailing address

6338 CHURCH STREET
CHINCOTEAGUE VA
23336
US

V. Phone/Fax

Practice location:
  • Phone: 757-990-1287
  • Fax: 757-336-2211
Mailing address:
  • Phone: 757-990-1287
  • Fax: 410-912-6386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD68067
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC1-0008915
License Number StateDE
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101039931
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: