Provider Demographics
NPI:1962021295
Name:WORTMAN, JOSEPH DANIEL
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:DANIEL
Last Name:WORTMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 STANTONSBURG RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-2818
Mailing Address - Country:US
Mailing Address - Phone:619-947-0261
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL CENTER BOULEVARD ORTHO DEPARTMENT
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-2818
Practice Address - Country:US
Practice Address - Phone:619-947-0261
Practice Address - Fax:336-716-1595
Is Sole Proprietor?:No
Enumeration Date:2020-04-16
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2024-01956208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation