Provider Demographics
NPI:1740332915
Name:WOHLTMANN, VIRGINIA ANN (MD)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:ANN
Last Name:WOHLTMANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 CROSS KEYS OFFICE PARK
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-3506
Mailing Address - Country:US
Mailing Address - Phone:585-425-1160
Mailing Address - Fax:585-425-1552
Practice Address - Street 1:490 CROSS KEYS OFFICE PARK
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-3506
Practice Address - Country:US
Practice Address - Phone:585-425-1160
Practice Address - Fax:585-425-1552
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1419932084P0804X, 2084P0805X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ70008Medicare PIN
NYB72447Medicare UPIN