MEDICARE: JEFFREY M WENTWORTH 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	207V00000X	Obstetrics & Gynecology Physician	0101224207	VA

General Provider Information

NPI Number	:	1316957251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY M WENTWORTH M.D.

Provider Business Mailing Address
First Line	:	880 KEMPSVILLE RD
Second Line	:	SUITE 2200
City	:	NORFOLK
State	:	VA
Zip	:	23502-3931
Country	:	US
Telephone Number	:	757-466-6350
Fax Number	:	757-466-9262

Provider Business Practice Location Address
First Line	:	880 KEMPSVILLE RD
Second Line	:	SUITE 2200
City	:	NORFOLK
State	:	VA
Zip	:	23502-3931
Country	:	US
Telephone Number	:	757-466-6350
Fax Number	:	757-466-9262

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

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	03/02/2010

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