MEDICARE: MORRIS WORTMAN MD PLLC

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	207VG0400X	Gynecology Physician	138183-1	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	BA0672	OTHER	NY	MEDICARE

General Provider Information

NPI Number	:	1700058575
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MORRIS WORTMAN MD PLLC

Provider Business Mailing Address
First Line	:	2020 S CLINTON AVE
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14618-5703
Country	:	US
Telephone Number	:	585-473-8770
Fax Number	:	585-473-8853

Provider Business Practice Location Address
First Line	:	2020 S CLINTON AVE
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14618-5703
Country	:	US
Telephone Number	:	585-473-8770
Fax Number	:	585-473-8853

Authorized Official
Title or Position	:	OWNER
Name	:	MORRIS WORTMAN
Credential	:	MD
Telephone Number	:	585-473-8770

Provider Enumeration Date	:	04/01/2008
Last Update Date	:	01/23/2009

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