Provider Demographics
NPI:1407837370
Name:WORTZEL, SANDRA H (MD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:H
Last Name:WORTZEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 CIVIC CENTER BLVD
Mailing Address - Street 2:SUITE 1-330S
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-5127
Mailing Address - Country:US
Mailing Address - Phone:215-662-2737
Mailing Address - Fax:215-752-8807
Practice Address - Street 1:3400 CIVIC CENTER BLVD
Practice Address - Street 2:SUITE 1-330S
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-5127
Practice Address - Country:US
Practice Address - Phone:215-662-2737
Practice Address - Fax:215-752-8807
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-039455E207N00000X
PAMD039455E207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E83871Medicare UPIN
PA669770E48Medicare PIN