Healthcare Provider Details

I. General information

NPI: 1700058575
Provider Name (Legal Business Name): MORRIS WORTMAN MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2008
Last Update Date: 01/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 S CLINTON AVE
ROCHESTER NY
14618-5703
US

IV. Provider business mailing address

2020 S CLINTON AVE
ROCHESTER NY
14618-5703
US

V. Phone/Fax

Practice location:
  • Phone: 585-473-8770
  • Fax: 585-473-8853
Mailing address:
  • Phone: 585-473-8770
  • Fax: 585-473-8853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number138183-1
License Number StateNY

VIII. Authorized Official

Name: MORRIS WORTMAN
Title or Position: OWNER
Credential: MD
Phone: 585-473-8770