Provider Demographics
NPI:1114325883
Name:WELLESLEY WOUND CARE LLC
Entity Type:Organization
Organization Name:WELLESLEY WOUND CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IKRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:FAROOQI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-898-7301
Mailing Address - Street 1:78 CLAYBROOK RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02030-2113
Mailing Address - Country:US
Mailing Address - Phone:781-898-7301
Mailing Address - Fax:781-898-7302
Practice Address - Street 1:65 WALNUT ST
Practice Address - Street 2:SUITE 360
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-2118
Practice Address - Country:US
Practice Address - Phone:781-898-7301
Practice Address - Fax:781-898-7302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-12
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center