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General NPI Number Information
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NPI Number | 1336130152
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Entity Type | Individual
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Provider Name | DAVID SHANE WOLF D.O.
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Gender | Male
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Dates
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Enumeration Date | 11/01/2005
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Last Update Date | 08/21/2020
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Provider Practice Location Address
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Address Line | 205 S FRONT ST STE 907
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City | HARRISBURG
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State | PA
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Zip | 17104-1619
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Country | US
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Telephone | 717-231-8313
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Fax |
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Provider Business Mailing Address
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Address Line | 205 S FRONT ST STE 907
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City | HARRISBURG
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State | PA
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Zip | 17104-1619
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | 229896-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | OS017863
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License Number State | PA
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