Provider Demographics
NPI:1568798734
Name:ADVANCED WOUND CARE OF NEW ENGLAND, P.C.
Entity Type:Organization
Organization Name:ADVANCED WOUND CARE OF NEW ENGLAND, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAVIS
Authorized Official - Middle Name:WEBSTER
Authorized Official - Last Name:JAWORSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-225-0022
Mailing Address - Street 1:PO BOX 511
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-0411
Mailing Address - Country:US
Mailing Address - Phone:978-225-0022
Mailing Address - Fax:
Practice Address - Street 1:25 HALE ST
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-5268
Practice Address - Country:US
Practice Address - Phone:978-225-0022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-23
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA151523207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty