Healthcare Provider Details

I. General information

NPI: 1861586802
Provider Name (Legal Business Name): LORN A WOLFE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 12/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2287 S MOUNTAINEER HWY
THORNTON WV
26440-7171
US

IV. Provider business mailing address

2287 S MOUNTAINEER HWY
THORNTON WV
26440-7171
US

V. Phone/Fax

Practice location:
  • Phone: 304-265-6963
  • Fax: 304-265-6961
Mailing address:
  • Phone: 304-265-6963
  • Fax: 304-265-6961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. CYNTHIA D WOLFE
Title or Position: OFFICE MANAGER
Credential:
Phone: 304-265-6963