Healthcare Provider Details

I. General information

NPI: 1770560054
Provider Name (Legal Business Name): NORMAN A WORTZMAN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 03/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

389 HANCOCK ST
NORTH QUINCY MA
02171-2406
US

IV. Provider business mailing address

389-B HANCOCK ST
NORTH QUINCY MA
02171-2406
US

V. Phone/Fax

Practice location:
  • Phone: 617-328-4550
  • Fax: 617-328-4550
Mailing address:
  • Phone: 617-328-4550
  • Fax: 617-328-4550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number1531
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: