Provider Demographics
NPI:1386331676
Name:WOUND MD PA PLLC
Entity type:Organization
Organization Name:WOUND MD PA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AZMAT
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-300-3830
Mailing Address - Street 1:8133 LEESBURG PIKE STE 630
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2730
Mailing Address - Country:US
Mailing Address - Phone:855-479-4217
Mailing Address - Fax:888-557-9724
Practice Address - Street 1:905 W SPROUL RD STE 106
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-1254
Practice Address - Country:US
Practice Address - Phone:855-479-4217
Practice Address - Fax:888-557-9724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Multi-Specialty