Healthcare Provider Details

I. General information

NPI: 1437198363
Provider Name (Legal Business Name): JOHN J WORTHINGTON MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 YORK RD
WILLOW GROVE PA
19090-1318
US

IV. Provider business mailing address

569 APPLEWOOD DR
FORT WASHINGTON PA
19034-3017
US

V. Phone/Fax

Practice location:
  • Phone: 215-657-9880
  • Fax: 215-657-1128
Mailing address:
  • Phone: 215-542-3920
  • Fax: 215-784-1128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberMD009352E
License Number StatePA

VIII. Authorized Official

Name: JOHN J WORTHINGTON
Title or Position: SR PSYCHIATRY
Credential: MD
Phone: 215-657-9880