Provider Demographics
NPI:1982761102
Name:NORSWORTHY, ERIC A (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:A
Last Name:NORSWORTHY
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 1:1219 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BEAVER DAM
Mailing Address - State:KY
Mailing Address - Zip Code:42320
Mailing Address - Country:US
Mailing Address - Phone:270-274-1800
Mailing Address - Fax:270-274-5600
Practice Address - Street 1:1219 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BEAVER DAM
Practice Address - State:KY
Practice Address - Zip Code:42320-8955
Practice Address - Country:US
Practice Address - Phone:270-274-1800
Practice Address - Fax:270-274-5600
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20834207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1001684OtherMETRACOMP
010028566OtherRAILROAD MEDICARE
KY65917551OtherKENPAC
KY1059763OtherPASSPORT
610901982OtherBENESIGHT
610901982OtherCENTERCARE
610901982003OtherCIGNA
610901982AOtherHUMANA
KY6423841Medicaid
KY000000045905OtherANTHEM BLUE CROSS
F12OtherOPERATING ENGINEERS
1160851OtherCHA HEALTH
AETNAOther443632
KY0101OtherJOHN DEERE
010619500OtherBLACK LUNG
610901982OtherBLUEGRASS FAMILY HEALTH
P00020977OtherRAILROAD RETIREMENT
610901982OtherBENESIGHT
610901982OtherBLUEGRASS FAMILY HEALTH