Provider Demographics
NPI:1740285030
Name:WOHLGEMUTH, STEPHEN DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:DAVID
Last Name:WOHLGEMUTH
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 1:6160 KEMPSVILLE CIR
Mailing Address - Street 2:STE 101B
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3933
Mailing Address - Country:US
Mailing Address - Phone:757-461-2515
Mailing Address - Fax:757-466-1104
Practice Address - Street 1:6160 KEMPSVILLE CIR
Practice Address - Street 2:STE 101B
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3933
Practice Address - Country:US
Practice Address - Phone:757-461-2515
Practice Address - Fax:757-466-1104
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101042440174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007307802Medicaid
VA007307802Medicaid
VAB06324Medicare UPIN