Provider Demographics
NPI:1114083607
Name:WORSHAM, ROBERTA E (PA)
Entity Type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:E
Last Name:WORSHAM
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RSS 2SCR
Mailing Address - Street 2:CMR 411 BOX 3663
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09112
Mailing Address - Country:DE
Mailing Address - Phone:011491-762-8631
Mailing Address - Fax:
Practice Address - Street 1:RSS 2SCR
Practice Address - Street 2:CMR 411 BOX 3663
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09112
Practice Address - Country:DE
Practice Address - Phone:0114-996-6283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical