Provider Demographics
NPI:1407107675
Name:OLTMAN, CARL FREDRICK SR (PA-C)
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:FREDRICK
Last Name:OLTMAN
Suffix:SR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 TYLER AVE
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-1909
Mailing Address - Country:US
Mailing Address - Phone:410-991-0493
Mailing Address - Fax:410-267-7892
Practice Address - Street 1:1003 TYLER AVE
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21403-1909
Practice Address - Country:US
Practice Address - Phone:410-991-0493
Practice Address - Fax:410-267-7892
Is Sole Proprietor?:No
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDCOOO1407363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical