Provider Demographics
NPI:1376351965
Name:MONTCO WOUND AND PRIMARY CARE CENTER PC
Entity type:Organization
Organization Name:MONTCO WOUND AND PRIMARY CARE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:LETIZIO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:484-378-2424
Mailing Address - Street 1:583 SHOEMAKER RD
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-4201
Mailing Address - Country:US
Mailing Address - Phone:484-378-2424
Mailing Address - Fax:484-723-5324
Practice Address - Street 1:583 SHOEMAKER RD
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-4201
Practice Address - Country:US
Practice Address - Phone:484-378-2424
Practice Address - Fax:484-723-5324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-27
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Multi-Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty