Provider Demographics
NPI:1811967284
Name:WORTMANN, ROBERT LEWIS (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LEWIS
Last Name:WORTMANN
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 1:1 MEDICAL CENTER DR
Mailing Address - Street 2:DHMC RHEUMATOLOGY
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03756-1000
Mailing Address - Country:US
Mailing Address - Phone:603-650-8622
Mailing Address - Fax:603-650-4961
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:DHMC RHEUMATOLOGY
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03756-1000
Practice Address - Country:US
Practice Address - Phone:603-650-8622
Practice Address - Fax:603-650-4961
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21391207R00000X, 207RR0500X
NH13650207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1014213Medicaid
OK100195840BMedicaid
NH30207209Medicaid
NH30207209Medicaid
242401605Medicare PIN
VT1014213Medicaid