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General NPI Number Information
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NPI Number | 1063816155
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Entity Type | Organization
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Legal Business Name | NOVA WOUND CARE, P.C.
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Dates
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Enumeration Date | 10/17/2014
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Last Update Date | 03/08/2019
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Provider Practice Location Address
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Address Line | 3700 JOSEPH SIEWICK DR 303
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City | FAIRFAX
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State | VA
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Zip | 22033-1744
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Country | US
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Telephone | 703-664-8025
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Fax | 703-652-8470
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Provider Business Mailing Address
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Address Line | 115 BEULAH RD NE 100D
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City | VIENNA
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State | VA
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Zip | 22180-4749
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Country | US
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Telephone | 703-652-4251
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Fax | 703-652-8470
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | TIMOTHY R LAPHAM
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Credential | MD
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Telephone | 703-876-2710
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0101240684
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License Number State | VA
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