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General NPI Number Information
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NPI Number | 1477628485
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Entity Type | Organization
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Legal Business Name | MOBILE WOUND CONSULTANTS
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1900 S BROAD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19145-2304
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Country | US
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Telephone | 856-845-0500
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Fax | 856-384-8757
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Provider Business Mailing Address
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Address Line | 127 N BROAD ST
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City | WOODBURY
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State | NJ
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Zip | 08096-1718
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Country | US
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Telephone | 856-845-0500
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Fax | 856-384-8757
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Authorized Official
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Title or Position | PARTNER
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Name | THERESA BRADY
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Credential | CRNP
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Telephone | 856-845-0500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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