Basic Information
| Provider Information | |||||||||
| NPI: | 1255337168 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOLFE | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 785 5TH AVE STE 3 | ||||||||
| Address2: | |||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172014232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172639555 | ||||||||
| FaxNumber: | 7177096529 | ||||||||
| Practice Location | |||||||||
| Address1: | 120 N 7TH ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172011795 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172176800 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2005 | ||||||||
| LastUpdateDate: | 04/13/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | MA002200L | PA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | 363A00000X | MA002200L | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | MW0244967 | 01 | PA | DEA | OTHER | P00841791 | 01 | PA | RAILROAD MEDICARE | OTHER | 25-1716306 | 01 | PA | INFORMED | OTHER | 9436544 | 01 | PA | AETNA NON HMO | OTHER | 50119323 | 01 | PA | CAPITAL BLUE CROSS | OTHER | 6382314 | 01 | PA | AETNA HMO | OTHER | 120420423 | 01 | PA | DEPT OF LABOR | OTHER | 1255337168 | 01 | PA | HEALTH AMERICA | OTHER | 25-1716306 | 01 | PA | DEVON | OTHER | 25-1716306 | 01 | PA | FIRST HEALTH | OTHER | 867633 | 01 | PA | MEDICARE GROUP # | OTHER | 103181790 | 05 | PA | MEDICAID | 25-1716306 | 01 | PA | TRICARE | OTHER | 25-1716306 | 01 | PA | INTERGROUP | OTHER | 25-1716306 | 01 | PA | PHCS/MULTI PLAN | OTHER | 50072051 | 01 | PA | CAPITAL BLUE CROSS | OTHER | MA002200L | 01 | PA | LICENSE | OTHER |