MEDICARE: DOUGLAS D. WOLFE, D.O., INC.

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

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

General Provider Information

NPI Number	:	1891892956
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOUGLAS D. WOLFE, D.O., INC.

Provider Business Mailing Address
First Line	:	800 E MAIN ST
Second Line	:	SUITE B
City	:	MANNINGTON
State	:	WV
Zip	:	26582-1215
Country	:	US
Telephone Number	:	304-986-2996
Fax Number	:	304-986-2998

Provider Business Practice Location Address
First Line	:	800 E MAIN ST
Second Line	:	SUITE B
City	:	MANNINGTON
State	:	WV
Zip	:	26582-1215
Country	:	US
Telephone Number	:	304-986-2996
Fax Number	:	304-986-2998

Authorized Official
Title or Position	:	OWNER
Name	:	DOUGLAS D WOLFE
Credential	:	D.O.
Telephone Number	:	304-986-2996

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	08/05/2010

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