Basic Information
Provider Information | |||||||||
NPI: | 1437594363 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | WOLF | ||||||||
FirstName: | BRIAN | ||||||||
MiddleName: | C | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 11350 MCCORMICK RD | ||||||||
Address2: | EXECUTIVE PLAZA 1, STE. 501 | ||||||||
City: | HUNT VALLEY | ||||||||
State: | MD | ||||||||
PostalCode: | 21031 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7039148000 | ||||||||
FaxNumber: | 4103291054 | ||||||||
Practice Location | |||||||||
Address1: | 251 KEISLER DR STE 101 | ||||||||
Address2: |   | ||||||||
City: | CARY | ||||||||
State: | NC | ||||||||
PostalCode: | 275187091 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9198030813 | ||||||||
FaxNumber: | 9198030967 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/06/2013 | ||||||||
LastUpdateDate: | 07/27/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 07/27/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2083A0100X | 13341 | ND | N |   | Allopathic & Osteopathic Physicians | Preventive Medicine | Aerospace Medicine | 390200000X |   |   | N |   | Student, Health Care | Student in an Organized Health Care Education/Training Program |   | 207LP2900X | 2022-00988 | NC | Y |   | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.