=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154863371
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DELAWARE VALLEY WOUND CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2016
-----------------------------------------------------
Last Update Date | 11/07/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 130 S. BRYN MAWR AVE
-----------------------------------------------------
City | BRYN MAWR
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-316-6611
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20833 CALEB JONES RD
-----------------------------------------------------
City | EWELL
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21824
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-316-6611
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ROBERT FLOROS
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 610-316-6611
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------