Provider Demographics
NPI:1548261209
Name:WOLCOTT, OLIVER (MD)
Entity type:Individual
Prefix:DR
First Name:OLIVER
Middle Name:
Last Name:WOLCOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2309 CLERMONT ST.
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80207-3134
Mailing Address - Country:US
Mailing Address - Phone:303-399-2098
Mailing Address - Fax:303-399-4639
Practice Address - Street 1:950 SOUTH CHERRY STREET
Practice Address - Street 2:SUITE 314
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-2662
Practice Address - Country:US
Practice Address - Phone:303-399-2098
Practice Address - Fax:303-399-4639
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMD135252084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01135250Medicaid
46669Medicare ID - Type Unspecified
CO01135250Medicaid
CO97751Medicare PIN