Provider Demographics
NPI:1801849369
Name:WOLGAMOT, GREGORY MICHAEL (MD, PHD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:MICHAEL
Last Name:WOLGAMOT
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3560 MERIDIAN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1731
Mailing Address - Country:US
Mailing Address - Phone:360-734-2800
Mailing Address - Fax:360-734-3818
Practice Address - Street 1:3614 MERIDIAN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1748
Practice Address - Country:US
Practice Address - Phone:360-734-2800
Practice Address - Fax:360-734-3818
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIXXXXXXXX207ZP0102X, 207ZD0900X
AZ53236207ZP0102X
MT28680207ZP0102X
NV14756207ZP0102X
ORMD169459207ZP0102X
IDM-12747207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMD00043141OtherMEDICAL LICENSE
AKMD5170WMedicaid
AKMEDS5895OtherMEDICAL LICENSE
WA3866WOOtherREGENCE BLUE SHIELD