Provider Demographics
NPI:1881861326
Name:WENTWORTH, JUSTIN RAY (DO)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:RAY
Last Name:WENTWORTH
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 1:8775 NORWIN AVE
Mailing Address - Street 2:
Mailing Address - City:IRWIN
Mailing Address - State:PA
Mailing Address - Zip Code:15642-2718
Mailing Address - Country:US
Mailing Address - Phone:724-861-6300
Mailing Address - Fax:724-863-0046
Practice Address - Street 1:8775 NORWIN AVE
Practice Address - Street 2:
Practice Address - City:IRWIN
Practice Address - State:PA
Practice Address - Zip Code:15642-2718
Practice Address - Country:US
Practice Address - Phone:724-861-6300
Practice Address - Fax:724-863-0046
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS014539207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102699705Medicaid
PA102699705Medicaid