Provider Demographics
NPI:1770560054
Name:WORTZMAN, NORMAN A (DPM)
Entity type:Individual
Prefix:
First Name:NORMAN
Middle Name:A
Last Name:WORTZMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:389-B HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:NORTH QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02171-2406
Mailing Address - Country:US
Mailing Address - Phone:617-328-4550
Mailing Address - Fax:617-328-4550
Practice Address - Street 1:389 HANCOCK ST
Practice Address - Street 2:
Practice Address - City:NORTH QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02171-2406
Practice Address - Country:US
Practice Address - Phone:617-328-4550
Practice Address - Fax:617-328-4550
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-28
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1531213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0338087Medicaid
MA33060OtherHARVARD PILGRIM HEALTH
MA708200OtherTUFTS HEALTH PLAN
MAY70655OtherBCBS MA
MA0005890OtherNEIGHBORHOOD HEALTH PLAN
MA33060OtherHARVARD PILGRIM HEALTH
MA0338087Medicaid
MAY70655OtherBCBS MA