Healthcare Provider Details

I. General information

NPI: 1386331676
Provider Name (Legal Business Name): WOUND MD PA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 W SPROUL RD STE 106
SPRINGFIELD PA
19064-1254
US

IV. Provider business mailing address

8133 LEESBURG PIKE STE 630
VIENNA VA
22182-2730
US

V. Phone/Fax

Practice location:
  • Phone: 855-479-4217
  • Fax: 888-557-9724
Mailing address:
  • Phone: 855-479-4217
  • Fax: 888-557-9724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: AZMAT HUSAIN
Title or Position: OWNER
Credential:
Phone: 410-300-3830