Provider Demographics
NPI:1053369702
Name:JUDITH A WOLFE MD PC
Entity type:Organization
Organization Name:JUDITH A WOLFE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-535-7107
Mailing Address - Street 1:POST OFFICE BOX 728
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15907-0728
Mailing Address - Country:US
Mailing Address - Phone:814-539-7107
Mailing Address - Fax:814-533-1885
Practice Address - Street 1:1020 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-4109
Practice Address - Country:US
Practice Address - Phone:814-535-7107
Practice Address - Fax:814-533-1885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036775L207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
038588OtherHIGHMARK
1355829OtherUMWA
PA0007231730003Medicaid
12735OtherUPMC
038588OtherHIGHMARK
PAW038588Medicare ID - Type Unspecified