Healthcare Provider Details

I. General information

NPI: 1417375692
Provider Name (Legal Business Name): JAMIE CLARE WORSLEY D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAMIE CLARE CICCARELLI D.O

II. Dates (important events)

Enumeration Date: 04/03/2014
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16605 KENDLE RD
WILLIAMSPORT MD
21795
US

IV. Provider business mailing address

7250 PARKWAY DR STE 500
HANOVER MD
21076-1343
US

V. Phone/Fax

Practice location:
  • Phone: 301-223-1241
  • Fax:
Mailing address:
  • Phone: 443-949-0814
  • Fax: 443-949-0825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberH0082811
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: