Healthcare Provider Details

I. General information

NPI: 1740332915
Provider Name (Legal Business Name): VIRGINIA ANN WOHLTMANN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 CROSS KEYS OFFICE PARK
FAIRPORT NY
14450-3506
US

IV. Provider business mailing address

490 CROSS KEYS OFFICE PARK
FAIRPORT NY
14450-3506
US

V. Phone/Fax

Practice location:
  • Phone: 585-425-1160
  • Fax: 585-425-1552
Mailing address:
  • Phone: 585-425-1160
  • Fax: 585-425-1552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number141993
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number141993
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number141993
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: