Healthcare Provider Details

I. General information

NPI: 1134177322
Provider Name (Legal Business Name): ROBERT MATHEW WOLTERMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 01/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 UNIVERSITY CT STE 2700
WEST CHESTER OH
45069-6542
US

IV. Provider business mailing address

PO BOX 636256 CENTRAL CREDENTIALING
CINCINNATI OH
45263-6256
US

V. Phone/Fax

Practice location:
  • Phone: 513-475-7452
  • Fax: 513-475-7453
Mailing address:
  • Phone: 513-585-5501
  • Fax: 513-585-5511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35-078089
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35-078089
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: