MEDICARE: DR. DAVID WURTZEL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208VP0000X	Pain Medicine Physician	25MA04422400	NJ

General Provider Information

NPI Number	:	1063441566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID WURTZEL M.D.

Provider Business Mailing Address
First Line	:	219 COUNTRYSIDE LN
Second Line	:
City	:	MOUNT LAUREL
State	:	NJ
Zip	:	08054-1023
Country	:	US
Telephone Number	:	856-722-1053
Fax Number	:

Provider Business Practice Location Address
First Line	:	1030 KINGS HWY N
Second Line	:
City	:	CHERRY HILL
State	:	NJ
Zip	:	08034-1907
Country	:	US
Telephone Number	:	856-779-7774
Fax Number	:	856-779-7787

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	07/08/2007

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