Provider Demographics
NPI:1245227776
Name:WORMER, DUNCAN D (MD)
Entity type:Individual
Prefix:
First Name:DUNCAN
Middle Name:D
Last Name:WORMER
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 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 679B
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-275-6168
Mailing Address - Fax:585-341-4213
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0002
Practice Address - Country:US
Practice Address - Phone:585-275-6168
Practice Address - Fax:585-341-4213
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY151006207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00816399Medicaid
NY060033830Medicare PIN
NY39085FMedicare PIN
NYRB8074Medicare PIN
NY00816399Medicaid
NY060049099Medicare PIN
B82326Medicare UPIN