Doctor Name: | DR. SHANNON MICHEAL WOLFE |
NPI Number: | 1275586463 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 0101223870 |
Business Practice Address: | 1501 Maple Ave Nw Mob Suite 200 Richmond, VA - 232262553 |
Business Phone Number: | 8042852300 |
Business Fax Number: | 8042858420 |
Mailing Address: | Po Box 71690, RICHMOND |
State: | VA |
Postal Code: | 232551690 |
Phone Number: | 8042852300 |
Fax Number: | 8042858420 |
NPI Enumeration Date: | 05/18/2006 |
NPI Last Update Date: | 01/23/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 0101223870 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |