Provider Demographics
NPI:1275659096
Name:VOLTIN, RUSSELL IRVIN (MD)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:IRVIN
Last Name:VOLTIN
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 1:312 6TH AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25303-1265
Mailing Address - Country:US
Mailing Address - Phone:304-768-6170
Mailing Address - Fax:304-768-2099
Practice Address - Street 1:312 6TH AVE STE 2
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25303-1265
Practice Address - Country:US
Practice Address - Phone:304-768-6170
Practice Address - Fax:304-768-2099
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV159942084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV000504283OtherBLUE CROSS OF WV
WVF37390Medicare UPIN
WV0724506Medicare PIN