NPIMap

Organization Active NPI

Eric R. Wolf, M.D., P.C.

  • Dermatology Physician
  • Groton, CT
National Provider Identifier
1447459672
Registry record updated Jul 17, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
023620 Issued in CT
Legal business name
ERIC R. WOLF, M.D., P.C.
Practice address
495 Gold Star Hwy
Suite 108
Groton, CT 06340-6228
Phone
(860) 449-9090
Fax
(860) 445-7246
NPI assigned
Jul 17, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Eric R. Wolf, M.D.
Title
President
Phone
(860) 449-9090

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X 023620 CT Primary

Addresses

Primary practice location

495 Gold Star Hwy
Suite 108
Groton, CT 06340-6228

Mailing address

495 Gold Star Hwy
Suite 108
Groton, CT 06340-6228
Phone (860) 449-9090

Other identifiers 1

IdentifierTypeStateIssuer
1236207MedicaidCT

Other names 1

  • ERIC R. WOLF, M.D., P.C. Other name

National Provider Directory

National Provider Directory

Locations

495 Route 184
Ste 108
Groton, CT 06340
Phone (860) 449-9090

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1184630400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184630400000",
    "number": "1447459672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "495 GOLD STAR HWY",
            "address_2": "SUITE 108",
            "city": "GROTON",
            "state": "CT",
            "postal_code": "063406228",
            "telephone_number": "860-449-9090",
            "fax_number": "860-445-7246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "495 GOLD STAR HWY",
            "address_2": "SUITE 108",
            "city": "GROTON",
            "state": "CT",
            "postal_code": "063406228",
            "telephone_number": "860-449-9090",
            "fax_number": "860-445-7246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ERIC R. WOLF, M.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-17",
        "last_updated": "2007-07-17",
        "status": "A",
        "authorized_official_last_name": "WOLF",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "860-449-9090",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "CT",
            "license": "023620",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1236207",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ERIC R. WOLF, M.D., P.C.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Groton, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.