MEDICARE: ROBERT C WOLLMAN MD

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	2085R0001X	Radiation Oncology Physician	G78624	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	WG78624J	OTHER	CA	MEDICARE SP
3	920001237	OTHER	CA	RR MEDICARE - SJHC
4	WG78624E	OTHER	CA	MEDICARE SJMC
5	WG78624F	OTHER	CA	MEDICARE SJHC
6	WG78624I	OTHER	CA	MEDICARE LCM
7	WG78624K	OTHER		MEDICARE SJO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437134665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT C WOLLMAN MD

Provider Business Mailing Address
First Line	:	PO BOX 512185
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90051-0185
Country	:	US
Telephone Number	:	626-775-3514
Fax Number	:

Provider Business Practice Location Address
First Line	:	1328 22ND ST
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90404-2032
Country	:	US
Telephone Number	:	310-829-8913
Fax Number	:	310-315-6168

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

Provider Enumeration Date	:	12/09/2005
Last Update Date	:	11/23/2020

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Directions to “ ROBERT C WOLLMAN MD” Practice Location

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