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General NPI Number Information
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NPI Number | 1942074653
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Entity Type | Organization
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Legal Business Name | AMERICAN WOUND CARE MEDICINE PLLC
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Dates
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Enumeration Date | 11/13/2023
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Last Update Date | 03/04/2025
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Provider Practice Location Address
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Address Line | 3514 MERMAID AVE
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City | BROOKLYN
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State | NY
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Zip | 11224-1508
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Country | US
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Telephone | 251-901-3011
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8209
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City | VIENNA
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State | VA
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Zip | 22183-2058
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SABA AZIZI-GHANNAD
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Credential | DO
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Telephone | 251-901-3011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State |
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