MEDICARE: DR. GIL I WOLFE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	H7677	TX
2	2084N0400X	Neurology Physician	264033	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215995535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GIL I WOLFE MD

Provider Business Mailing Address
First Line	:	77 GOODELL ST STE 3
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14203-1243
Country	:	US
Telephone Number	:	716-878-2499
Fax Number	:	716-849-0149

Provider Business Practice Location Address
First Line	:	1010 MAIN ST
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14202-1102
Country	:	US
Telephone Number	:	716-323-0556
Fax Number	:	716-323-6674

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	09/02/2021

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