Healthcare Provider Details

I. General information

NPI: 1235918764
Provider Name (Legal Business Name): WOUND CARE SPECIALISTS OF MA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 CONCORD STREET
FRAMINGHAM MA
01701
US

IV. Provider business mailing address

76 BATTERSON PARK RD STE 106
FARMINGTON CT
06032-2571
US

V. Phone/Fax

Practice location:
  • Phone: 203-598-6045
  • Fax: 203-879-0834
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN BRENES
Title or Position: COO
Credential:
Phone: 203-598-6045