MEDICARE: KURUP WOUND CARE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	D0063681	MD

General Provider Information

NPI Number	:	1861652646
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KURUP WOUND CARE, INC.

Provider Business Mailing Address
First Line	:	1835 UNIVERSITY BLVD E
Second Line	:	STE 208
City	:	HYATTSVILLE
State	:	MD
Zip	:	20783-4600
Country	:	US
Telephone Number	:	301-873-9876
Fax Number	:	301-445-3502

Provider Business Practice Location Address
First Line	:	1835 UNIVERSITY BLVD E
Second Line	:	STE 208
City	:	HYATTSVILLE
State	:	MD
Zip	:	20783-4600
Country	:	US
Telephone Number	:	301-873-9876
Fax Number	:	301-445-3502

Authorized Official
Title or Position	:	OWNER / PRESIDENT
Name	:	DR. AJIT GOPAL KURUP
Credential	:	M.D.
Telephone Number	:	301-873-9876

Provider Enumeration Date	:	06/14/2008
Last Update Date	:	09/25/2012

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