MEDICARE: JAD WOUND CARE, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	163WW0000X	Wound Care Registered Nurse
2	163WX1500X	Ostomy Care Registered Nurse
3	363LA2200X	Adult Health Nurse Practitioner

General Provider Information

NPI Number	:	1891440566
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAD WOUND CARE, LLC

Provider Business Mailing Address
First Line	:	10320 WILDE LAKE TER
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21044-2529
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10463 OWEN BROWN RD
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21044-3835
Country	:	US
Telephone Number	:	301-660-5654
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ADAMA PANDA
Credential	:	CRNP
Telephone Number	:	240-533-1395

Provider Enumeration Date	:	02/21/2022
Last Update Date	:	02/22/2022

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Directions to “JAD WOUND CARE, LLC ” Practice Location

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