Wiltz, Othon

Wiltz, Othon is an individual health care provider with primary practice located at 3620 Joseph Siewick Dr Ste 406 , Fairfax VA 22033-1761. He recently has only one registered license in Allopathic & Osteopathic Physicians / Colon & Rectal Surgery, which is considered as his primary health care specialty. Wiltz, Othon can be contacted via phone (703) 359-8640.

Contact Information

Primary practice address
3620 Joseph Siewick Dr Ste 406 Fairfax VA 22033-1761
Phone: (703) 359-8640
Fax: (703) 591-6105
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Colon & Rectal Surgery 208C00000X 0101240155 Virginia
Allopathic & Osteopathic Physicians / Colon & Rectal Surgery 208C00000X 11687 Puerto Rico

Profile Details

NPI number 1174525869
LBN Legal business name Wiltz, Othon
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 11th, 2005
Last updated Jul 25th, 2017 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1174525869 NPPES
Puerto Rico Other 060957 LA CRUZ AZUL
Puerto Rico Other 601049 LA CRUZ AZUL
Puerto Rico Other SE4019 LA CRUZ AZUL
Puerto Rico MEDICAID 1174525869 LA CRUZ AZUL
Puerto Rico Other 1400005 LA CRUZ AZUL
Puerto Rico Other 311678 LA CRUZ AZUL
Puerto Rico Other 7113 LA CRUZ AZUL
Puerto Rico Other 89937 LA CRUZ AZUL

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