Provider Demographics
NPI:1285730671
Name:WORTMAN, SERGEY (MD)
Entity type:Individual
Prefix:
First Name:SERGEY
Middle Name:
Last Name:WORTMAN
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 WELBY RD STE 1E
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02745-1137
Mailing Address - Country:US
Mailing Address - Phone:508-998-8517
Mailing Address - Fax:774-328-9929
Practice Address - Street 1:2834 ACUSHNET AVE
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02745
Practice Address - Country:US
Practice Address - Phone:508-998-8517
Practice Address - Fax:508-998-1461
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA152325208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
321236OtherBCBS
2300085OtherUNITED HEALTHCARE
MA3136709Medicaid
689985OtherHARVARD PILGRIM
321236OtherBCBS
689985OtherHARVARD PILGRIM