Provider Demographics
NPI:1275522450
Name:WOLTMAN, TODD A (MD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:A
Last Name:WOLTMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3920 CAPITAL MALL DR SW STE 201
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-8702
Mailing Address - Country:US
Mailing Address - Phone:360-596-4880
Mailing Address - Fax:360-596-4881
Practice Address - Street 1:3920 CAPITAL MALL DR SW STE 201
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-8702
Practice Address - Country:US
Practice Address - Phone:360-596-4880
Practice Address - Fax:360-596-4881
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00042360208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0212184OtherLABOR & INDUSTRY
WA8365397Medicaid
WA9114WOOtherBLUE SHIELD
8861387Medicare PIN
WA8365397Medicaid