Provider Demographics
NPI:1760427504
Name:WURTHMANN, POLLY A (MD)
Entity Type:Individual
Prefix:
First Name:POLLY
Middle Name:A
Last Name:WURTHMANN
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:PO BOX 1583
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29465-1583
Mailing Address - Country:US
Mailing Address - Phone:843-343-3740
Mailing Address - Fax:843-375-0407
Practice Address - Street 1:1849 SAVAGE RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4726
Practice Address - Country:US
Practice Address - Phone:843-576-2588
Practice Address - Fax:843-576-2610
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18657174400000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No174400000XOther Service ProvidersSpecialist