Vladimir J Wormwood, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA-433 Issued in ME

Practice address

818 Congress St
Portland, ME 04102-3112

Phone

(207) 773-8161

Fax

(207) 773-1489

NPI assigned

Nov 6, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1358726400000",
    "number": "1417026634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301C US ROUTE 1",
            "city": "SCARBOROUGH",
            "state": "ME",
            "postal_code": "040749701",
            "telephone_number": "207-396-8600",
            "fax_number": "207-396-8632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "818 CONGRESS ST",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041023112",
            "telephone_number": "207-773-8161",
            "fax_number": "207-773-1489"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WORMWOOD",
        "first_name": "VLADIMIR",
        "middle_name": "J",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-06",
        "last_updated": "2013-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "ME",
            "license": "PA-433",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "312580099",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kate Russell Woodworth, M.D., M.P.H.
• Samuel Woodworth, MD
• Kysha Woodye, NP
• Ashley Woon
• Vance Wormwood, CRNA
• Kelly Anne Worster, D.C.
• Jenna Wozer, DO
• Daisy S. Wright, LCSW
• Lindsay Wright, PA
• Nancy Lynne Wright, FNP

• Surgical Physician Assistant in Portland, ME
• Providers in Portland, ME by specialty
• Surgical Physician Assistant in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.