MEDICARE: NEIL WOLFSON M.D.

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	207Q00000X	Family Medicine Physician	011634	LA
2	207VG0400X	Gynecology Physician	011634	LA

General Provider Information

NPI Number	:	1407827595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEIL WOLFSON M.D.

Provider Business Mailing Address
First Line	:	4525 TAFT PARK
Second Line	:
City	:	METAIRIE
State	:	LA
Zip	:	70002-1434
Country	:	US
Telephone Number	:	504-455-1773
Fax Number	:	504-455-7716

Provider Business Practice Location Address
First Line	:	4525 TAFT PARK
Second Line	:
City	:	METAIRIE
State	:	LA
Zip	:	70002-1434
Country	:	US
Telephone Number	:	504-455-1773
Fax Number	:	504-455-7716

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

Provider Enumeration Date	:	01/28/2006
Last Update Date	:	08/23/2011

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Directions to “ NEIL WOLFSON M.D.” Practice Location

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