Provider Demographics
NPI:1881965028
Name:RAYMOND D WOLF D.O. INC.
Entity type:Organization
Organization Name:RAYMOND D WOLF D.O. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:D
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:DO,RVT,RPVI
Authorized Official - Phone:937-839-4681
Mailing Address - Street 1:1 MARTY LN
Mailing Address - Street 2:
Mailing Address - City:WEST ALEXANDRIA
Mailing Address - State:OH
Mailing Address - Zip Code:45381-1165
Mailing Address - Country:US
Mailing Address - Phone:937-839-4681
Mailing Address - Fax:937-839-1126
Practice Address - Street 1:1 MARTY LN
Practice Address - Street 2:
Practice Address - City:WEST ALEXANDRIA
Practice Address - State:OH
Practice Address - Zip Code:45381-1165
Practice Address - Country:US
Practice Address - Phone:937-839-4681
Practice Address - Fax:937-839-1126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-4358-W261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHD97899Medicare UPIN