Basic Information
| Provider Information | |||||||||
| NPI: | 1417375692 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WORSLEY | ||||||||
| FirstName: | JAMIE | ||||||||
| MiddleName: | CLARE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CICCARELLI | ||||||||
| OtherFirstName: | JAMIE | ||||||||
| OtherMiddleName: | CLARE | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | D.O | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 7250 PARKWAY DR | ||||||||
| Address2: | STE 500 | ||||||||
| City: | HANOVER | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210761343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4439490814 | ||||||||
| FaxNumber: | 4439490825 | ||||||||
| Practice Location | |||||||||
| Address1: | 16605 KENDLE RD | ||||||||
| Address2: | |||||||||
| City: | WILLIAMSPORT | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21795 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012231241 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2014 | ||||||||
| LastUpdateDate: | 08/21/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | H0082811 | MD | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.