Healthcare Provider Details

I. General information

NPI: 1477520229
Provider Name (Legal Business Name): DOROTHY WOODWARD WORTMANN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 01/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE MEDICAL CENTER DRIVE DHMC RHEUMATOLOGY
LEBANON NH
03756-0001
US

IV. Provider business mailing address

ONE MEDICAL CENTER DRIVE DHMC RHEUMATOLOGY
LEBANON NH
03756-0001
US

V. Phone/Fax

Practice location:
  • Phone: 603-650-8622
  • Fax: 603-650-4961
Mailing address:
  • Phone: 603-650-8622
  • Fax: 603-650-4961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0216X
TaxonomyPediatric Rheumatology Physician
License Number21720
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code2080P0216X
TaxonomyPediatric Rheumatology Physician
License Number13842
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: