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General NPI Number Information
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NPI Number | 1518135441
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Entity Type | Organization
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Legal Business Name | CCRAB ASSOCIATES, LLC
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Dates
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Enumeration Date | 02/13/2008
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Last Update Date | 09/22/2008
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Provider Practice Location Address
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Address Line | 3261 OLD WASHINGTON RD SUITE 1010
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City | WALDORF
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State | MD
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Zip | 20602-3223
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Country | US
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Telephone | 301-645-0366
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Fax | 301-843-4773
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Provider Business Mailing Address
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Address Line | 3261 OLD WASHINGTON RD SUITE 1010
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City | WALDORF
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State | MD
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Zip | 20602-3223
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Country | US
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Telephone | 301-645-0366
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Fax | 301-843-4773
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DR. BRUCE A WENZEL
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Credential |
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Telephone | 301-645-0366
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 00399
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License Number State | MD
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