Provider Demographics
NPI:1447256763
Name:WOLFERT, IRWIN H (MD)
Entity type:Individual
Prefix:DR
First Name:IRWIN
Middle Name:H
Last Name:WOLFERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:605 N BETHLEHEM PIKE
Mailing Address - Street 2:
Mailing Address - City:LOWER GWYNEDD
Mailing Address - State:PA
Mailing Address - Zip Code:19002-2501
Mailing Address - Country:US
Mailing Address - Phone:215-643-3568
Mailing Address - Fax:215-643-3568
Practice Address - Street 1:605 N BETHLEHEM PIKE
Practice Address - Street 2:
Practice Address - City:LOWER GWYNEDD
Practice Address - State:PA
Practice Address - Zip Code:19002-2501
Practice Address - Country:US
Practice Address - Phone:215-643-3568
Practice Address - Fax:215-643-3568
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044067E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA564762Medicare PIN