Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 35035952 | OH |
NPI | 1003817495 |
---|---|
Provider Name | Dr. Daniel Worthington |
First Address | Chagrin Falls, OH 44022-0567 |
Second Address | Beachwood, OH 44122-5470 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2005 |
Last Update Date | 11/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0304898 | (05) | OH |
F28412 | (02) | OH |