Individual
OTHON WILTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3620 JOSEPH SIEWICK DR STE 406, FAIRFAX, VA 22033-1761
(703) 359-8640
(703) 591-6105
Mailing address
3620 JOSEPH SIEWICK DR, SUITE 406, FAIRFAX, VA 22033
(703) 359-8640
(703) 591-6105
Taxonomy
Speciality
Code
Description
License number
State
208C00000X
Colon & Rectal Surgery Physician
Primary
0101240155
VA
208C00000X
Colon & Rectal Surgery Physician
11687
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060957
LA CRUZ AZUL
PR
05
—
1174525869
—
VA
01
—
1400005
HUMANA
PR
01
—
311678
CIGNA
PR
01
—
601049
MMM
PR
01
—
7113
IMC
PR
01
—
89937
SSS
PR
01
—
SE4019
PALIC
PR
Enumeration date
08/11/2005
Last updated
07/25/2017
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