Healthcare Provider Details

I. General information

NPI: 1881348662
Provider Name (Legal Business Name): PENNSYLVANIA ADVANCED WOUND CARE AND LIMB SALVAGE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2022
Last Update Date: 02/09/2022
Certification Date: 02/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 E UWCHLAN AVE STE 102
EXTON PA
19341-1293
US

IV. Provider business mailing address

1450 E BOOT RD STE 600B
WEST CHESTER PA
19380-5968
US

V. Phone/Fax

Practice location:
  • Phone: 484-272-2880
  • Fax: 888-871-0040
Mailing address:
  • Phone: 610-430-8272
  • Fax: 888-871-0040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SEAN V RYAN
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 610-906-0377