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General NPI Number Information
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NPI Number | 1114325883
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Entity Type | Organization
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Legal Business Name | WELLESLEY WOUND CARE LLC
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Dates
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Enumeration Date | 12/12/2014
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Last Update Date | 12/12/2014
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Provider Practice Location Address
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Address Line | 65 WALNUT ST SUITE 360
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City | WELLESLEY
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State | MA
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Zip | 02481-2118
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Country | US
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Telephone | 781-898-7301
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Fax | 781-898-7302
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Provider Business Mailing Address
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Address Line | 78 CLAYBROOK RD
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City | DOVER
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State | MA
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Zip | 02030-2113
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Country | US
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Telephone | 781-898-7301
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Fax | 781-898-7302
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Authorized Official
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Title or Position | PRESIDENT
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Name | IKRAM FAROOQI
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Credential | MD
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Telephone | 781-898-7301
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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