Provider Demographics
NPI:1073564902
Name:WADSWORTH, STEVEN M (DPM)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:M
Last Name:WADSWORTH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:420 W MORRIS BLVD
Mailing Address - Street 2:STE 400D HEALTH STAR PHYSICIANS
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:39813
Mailing Address - Country:US
Mailing Address - Phone:423-586-7509
Mailing Address - Fax:423-581-5701
Practice Address - Street 1:420 W MORRIS BLVD
Practice Address - Street 2:STE 400D HEALTH STAR PHYSICIANS
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:39813
Practice Address - Country:US
Practice Address - Phone:423-586-7509
Practice Address - Fax:423-581-5701
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM514213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3352969Medicaid
U74368Medicare UPIN
TN3352969Medicaid