Provider Demographics
NPI:1376500280
Name:WADSWORTH, TROY W (MD)
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:W
Last Name:WADSWORTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 S 5TH ST
Mailing Address - Street 2:STE 3L
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4210
Mailing Address - Country:US
Mailing Address - Phone:253-403-1677
Mailing Address - Fax:
Practice Address - Street 1:1003 S 5TH ST
Practice Address - Street 2:STE 3L
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4210
Practice Address - Country:US
Practice Address - Phone:253-403-1677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD423960207RX0202X
WAMD00047830207RX0202X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAH96822Medicare UPIN