Provider Demographics
NPI:1629805502
Name:WOLF, AIDAN JOSEPH-FITZROY
Entity type:Individual
Prefix:
First Name:AIDAN
Middle Name:JOSEPH-FITZROY
Last Name:WOLF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 FAIRMOUNT BLVD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44106-3100
Mailing Address - Country:US
Mailing Address - Phone:216-390-9678
Mailing Address - Fax:
Practice Address - Street 1:2450 FAIRMOUNT BLVD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44106-3100
Practice Address - Country:US
Practice Address - Phone:216-390-9678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator