Healthcare Provider Details

I. General information

NPI: 1699777037
Provider Name (Legal Business Name): WARREN WOLFE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10620 SPOTSYLVANIA AVE
FREDERICKSBURG VA
22408-2637
US

IV. Provider business mailing address

10501 CHATHAM RIDGE WAY
SPOTSYLVANIA VA
22553-8911
US

V. Phone/Fax

Practice location:
  • Phone: 540-710-1086
  • Fax: 540-710-1126
Mailing address:
  • Phone: 856-625-9461
  • Fax: 540-972-4436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0102201461
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: