MEDICARE: DR. ROBERT WALTER WOHLFORT TH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PSY 653	DC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PSY 653	OTHER	DC	CLINICAL PSYCHOLOGIST

General Provider Information

NPI Number	:	1245255330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT WALTER WOHLFORT TH.D.

Provider Business Mailing Address
First Line	:	1625 K ST NW
Second Line	:	SUITE 310
City	:	WASHINGTON
State	:	DC
Zip	:	20006-1604
Country	:	US
Telephone Number	:	202-628-9177
Fax Number	:	804-725-2038

Provider Business Practice Location Address
First Line	:	1625 K ST NW
Second Line	:	SUITE 310
City	:	WASHINGTON
State	:	DC
Zip	:	20006-1604
Country	:	US
Telephone Number	:	202-628-9177
Fax Number	:	804-725-2038

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	07/08/2007

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