Provider Demographics
NPI:1366587115
Name:WOLFSON, PHILIP ELIHU (MD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:ELIHU
Last Name:WOLFSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6 CREST AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANSELMO
Mailing Address - State:CA
Mailing Address - Zip Code:94960-2553
Mailing Address - Country:US
Mailing Address - Phone:415-550-1700
Mailing Address - Fax:415-721-0895
Practice Address - Street 1:1255 POST ST
Practice Address - Street 2:SUITE 1150
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-6703
Practice Address - Country:US
Practice Address - Phone:415-550-1700
Practice Address - Fax:415-721-0895
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG335702084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G335700Medicare ID - Type Unspecified