Healthcare Provider Details

I. General information

NPI: 1255673943
Provider Name (Legal Business Name): NOVA WOUND CARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2013
Last Update Date: 10/27/2022
Certification Date: 10/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32370 LANKFORD HWY
PAINTER VA
23420-2410
US

IV. Provider business mailing address

32370 LANKFORD HWY
PAINTER VA
23420-2410
US

V. Phone/Fax

Practice location:
  • Phone: 757-782-9157
  • Fax: 703-652-8470
Mailing address:
  • Phone: 703-652-4251
  • Fax: 703-652-8470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY LAPHAM
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 703-652-4251