Healthcare Provider Details

I. General information

NPI: 1902925100
Provider Name (Legal Business Name): JOHN JASON WOLEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 04/05/2024
Certification Date: 04/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 ARMORY DR
WHEELING WV
26003-6370
US

IV. Provider business mailing address

109 MOUNT WOOD RD
WHEELING WV
26003-2632
US

V. Phone/Fax

Practice location:
  • Phone: 304-243-3160
  • Fax: 304-243-5095
Mailing address:
  • Phone: 304-233-2455
  • Fax: 304-233-6073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number22703
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: