Provider Demographics
NPI:1194838466
Name:AMERICAN WOUND HEALING CENTER
Entity Type:Organization
Organization Name:AMERICAN WOUND HEALING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGEMENT CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:MYRON
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:301-770-5033
Mailing Address - Street 1:PO BOX 374
Mailing Address - Street 2:
Mailing Address - City:MONKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21111-0374
Mailing Address - Country:US
Mailing Address - Phone:443-522-9749
Mailing Address - Fax:443-522-9725
Practice Address - Street 1:12230 ROCKVILLE PIKE
Practice Address - Street 2:SUITE 250
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-1672
Practice Address - Country:US
Practice Address - Phone:443-522-9749
Practice Address - Fax:443-522-9725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD670BAMOtherBLUESHIELD
DCK409OtherBLUESHIELD
MD5452690001Medicare NSC
DCK409OtherBLUESHIELD