Provider Demographics
NPI:1720778897
Name:WORTHINGTON, TYLER J (DO)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:J
Last Name:WORTHINGTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 N EWING ST STE 304
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-3379
Mailing Address - Country:US
Mailing Address - Phone:740-687-8397
Mailing Address - Fax:740-654-4130
Practice Address - Street 1:135 N EWING ST STE 30
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-3382
Practice Address - Country:US
Practice Address - Phone:740-687-8397
Practice Address - Fax:740-654-4103
Is Sole Proprietor?:No
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program