Healthcare Provider Details

I. General information

NPI: 1891440566
Provider Name (Legal Business Name): JAD WOUND CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2022
Last Update Date: 02/22/2022
Certification Date: 02/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10463 OWEN BROWN RD
COLUMBIA MD
21044-3835
US

IV. Provider business mailing address

10320 WILDE LAKE TER
COLUMBIA MD
21044-2529
US

V. Phone/Fax

Practice location:
  • Phone: 301-660-5654
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WX1500X
TaxonomyOstomy Care Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ADAMA PANDA
Title or Position: OWNER
Credential: CRNP
Phone: 240-533-1395