Healthcare Provider Details

I. General information

NPI: 1750737664
Provider Name (Legal Business Name): JARED R WORTZMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2016
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 MIDDLE ST
FALL RIVER MA
02721-1733
US

IV. Provider business mailing address

55 FRUIT ST
BOSTON MA
02114-2621
US

V. Phone/Fax

Practice location:
  • Phone: 508-996-3991
  • Fax:
Mailing address:
  • Phone: 617-726-3030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number282718
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD17363
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: