Active NPI
Bertil F Wolf, MD
- Gastroenterology Physician
- Lynn, MA
National Provider Identifier
1871549535
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gastroenterology Physician
- License
- 31674
- Practice address
- 496 Lynnfield St
Lynn, MA 01904 - Phone
- (781) 593-3400
- Fax
- (781) 477-1195
- NPI assigned
- May 25, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 31674 | MA | |
| Gastroenterology Physician | 207RG0100X | 31674 | MA | Primary |
Addresses
Primary practice location
496 Lynnfield St
Lynn, MA 01904
Mailing address
PO Box 930
Salem, MA 01970
Phone (978) 825-6581
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0194395 | Medicaid | MA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 31674 | MA | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148515200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1207526400000",
"number": "1871549535",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 930",
"city": "SALEM",
"state": "MA",
"postal_code": "01970",
"telephone_number": "978-825-6581",
"fax_number": "978-825-7070"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "496 LYNNFIELD ST",
"city": "LYNN",
"state": "MA",
"postal_code": "01904",
"telephone_number": "781-593-3400",
"fax_number": "781-477-1195"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOLF",
"first_name": "BERTIL",
"middle_name": "F",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-05-25",
"last_updated": "2008-04-07",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MA",
"license": "31674",
"primary": false
},
{
"code": "207RG0100X",
"taxonomy_group": "",
"desc": "Internal Medicine, Gastroenterology",
"state": "MA",
"license": "31674",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0194395",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lynn, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.