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General NPI Number Information
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NPI Number | 1356616817
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Entity Type | Individual
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Provider Name | BRADLEY R WOLF M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/16/2012
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Last Update Date | 03/16/2012
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Provider Practice Location Address
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Address Line | 11877 MASON RD
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City | CINCINNATI
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State | OH
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Zip | 45249-4714
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Country | US
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Telephone | 513-774-0400
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Fax | 513-774-0410
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Provider Business Mailing Address
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Address Line | 11877 MASON RD
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City | CINCINNATI
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State | OH
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Zip | 45249-4714
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Country | US
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Telephone | 513-774-0400
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Fax | 513-774-0410
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 35.052721
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License Number State | OH
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