Provider Demographics
NPI:1770457590
Name:EVOLUTION WOUND MANAGEMENT OF PA PC
Entity type:Organization
Organization Name:EVOLUTION WOUND MANAGEMENT OF PA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PC OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:EMDUR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:800-914-3592
Mailing Address - Street 1:242 W 53RD ST APT 48E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-7895
Mailing Address - Country:US
Mailing Address - Phone:800-914-3592
Mailing Address - Fax:800-897-1470
Practice Address - Street 1:502 W 7TH ST STE 100
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-1333
Practice Address - Country:US
Practice Address - Phone:800-914-3592
Practice Address - Fax:800-897-1470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-03
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty