Provider Demographics
NPI:1982678298
Name:WOLCOTT, CHARLES J II (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:J
Last Name:WOLCOTT
Suffix:II
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:PO BOX 276
Mailing Address - Street 2:
Mailing Address - City:FRANCONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03580-0276
Mailing Address - Country:US
Mailing Address - Phone:603-823-8517
Mailing Address - Fax:
Practice Address - Street 1:155 MAIN ST
Practice Address - Street 2:
Practice Address - City:FRANCONIA
Practice Address - State:NH
Practice Address - Zip Code:03580-4802
Practice Address - Country:US
Practice Address - Phone:603-823-7078
Practice Address - Fax:603-444-3441
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH5426207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30203393Medicaid
NH30203393Medicaid
NH4100Medicare ID - Type Unspecified