Provider Demographics
NPI:1588645451
Name:WORTZEL, RICHARD D (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:D
Last Name:WORTZEL
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 1:3400 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:218-752-8807
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 039074-E207N00000X
NJMA54018207N00000X
PAMD039074E207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0094865OtherAETNA
PA0324685000OtherKEYSTONE
E52781Medicare UPIN
PA421434E48Medicare PIN