Doctor Name: | DEVON WOOLFOLK |
NPI Number: | 1366811416 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA-C |
License Number: | MA057824 |
Business Practice Address: | 239 S Mountain Blvd Suite 100 Mountain Top, PA - 187071911 |
Business Phone Number: | 5707157950 |
Business Fax Number: | 5704740962 |
Mailing Address: | 610 Wyoming Ave, KINGSTON |
State: | PA |
Postal Code: | 187043702 |
Phone Number: | 5702885441 |
Fax Number: | 5702885842 |
NPI Enumeration Date: | 09/18/2015 |
NPI Last Update Date: | 09/18/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | MA057824 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |