Provider Demographics
NPI:1235292277
Name:WOLFE, ROY R JR (MD)
Entity type:Individual
Prefix:
First Name:ROY
Middle Name:R
Last Name:WOLFE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 463
Mailing Address - Street 2:
Mailing Address - City:GHENT
Mailing Address - State:WV
Mailing Address - Zip Code:25843-0463
Mailing Address - Country:US
Mailing Address - Phone:304-255-1541
Mailing Address - Fax:304-253-7067
Practice Address - Street 1:410 CARRIAGE DR
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-2806
Practice Address - Country:US
Practice Address - Phone:304-255-1541
Practice Address - Fax:304-253-7067
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20401207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2002090000Medicaid
WV2002090000Medicaid
WVW04043151Medicare ID - Type UnspecifiedMEDICARE