Provider Demographics
NPI:1851000913
Name:WOLTER, CLAIRE H (PA-C)
Entity Type:Individual
Prefix:
First Name:CLAIRE
Middle Name:H
Last Name:WOLTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 RAYMOND AVE
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-2633
Mailing Address - Country:US
Mailing Address - Phone:703-229-9279
Mailing Address - Fax:
Practice Address - Street 1:8120 GATEHOUSE RD FL 3
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-1204
Practice Address - Country:US
Practice Address - Phone:703-573-3687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110008933363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant