Basic Information
Provider Information
NPI: 1003295445
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WOLFE
FirstName: SAMANTHA
MiddleName: A
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 801 OSTRUM ST
Address2:  
City: BETHLEHEM
State: PA
PostalCode: 180151000
CountryCode: US
TelephoneNumber: 4845262255
FaxNumber:  
Practice Location
Address1: 801 OSTRUM ST
Address2:  
City: BETHLEHEM
State: PA
PostalCode: 180151000
CountryCode: US
TelephoneNumber: 4845262255
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/19/2015
LastUpdateDate: 09/14/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208600000XMT212067PAY Allopathic & Osteopathic PhysiciansSurgery 

No ID Information.


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