Healthcare Provider Details

I. General information

NPI: 1205946779
Provider Name (Legal Business Name): GLENN B. WOLFFE,M.D. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6295 TEAL LN
CHINCOTEAGUE VA
23336-2207
US

IV. Provider business mailing address

6295 TEAL LN
CHINCOTEAGUE VA
23336-2207
US

V. Phone/Fax

Practice location:
  • Phone: 757-336-2200
  • Fax: 757-336-2211
Mailing address:
  • Phone: 757-336-2200
  • Fax: 757-336-2211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number0101039931
License Number StateVA

VIII. Authorized Official

Name: DR. GLENN B. WOLFFE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 757-336-2200