MEDICARE: JEFFREY WOLPER PH.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	103TC0700X	Clinical Psychologist	PS005921L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	668005	OTHER	PA	PA BLUE SHIELD
2	0500938000	OTHER	PA	PERSONAL CHOICE

General Provider Information

NPI Number	:	1720183783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY WOLPER PH.D

Provider Business Mailing Address
First Line	:	1800 JOHN F KENNEDY BLVD
Second Line	:	SUITE 605
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-7421
Country	:	US
Telephone Number	:	267-977-0850
Fax Number	:	215-322-6067

Provider Business Practice Location Address
First Line	:	1800 JOHN F KENNEDY BLVD
Second Line	:	SUITE 605
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-7421
Country	:	US
Telephone Number	:	267-977-0850
Fax Number	:	215-322-6067

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

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	07/08/2007

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