Provider Demographics
NPI:1053348698
Name:WOLFE, STEVEN (DO)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:WOLFE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 LOND POND ROAD
Mailing Address - Street 2:EMERGENCY DEPARTMENT
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4122
Mailing Address - Country:US
Mailing Address - Phone:585-723-7005
Mailing Address - Fax:585-723-7045
Practice Address - Street 1:1555 LOND POND ROAD
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4122
Practice Address - Country:US
Practice Address - Phone:585-723-7005
Practice Address - Fax:585-723-7045
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174685207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02118505Medicaid
NY174685-8WOtherWORKER'S COMPENSATION
NY02118505Medicaid
NYRB7111Medicare PIN
NYJ400046411/GRP70008AMedicare PIN
NYJ400046412/GRPBA0017Medicare PIN
NYRB7111Medicare PIN
NYJ400046411/GRP70008AMedicare PIN