Provider Demographics
NPI:1396810438
Name:WOUND CONSULTANT OF WESTERN PA
Entity type:Organization
Organization Name:WOUND CONSULTANT OF WESTERN PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OLU
Authorized Official - Middle Name:R
Authorized Official - Last Name:SANGODEYI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-269-9665
Mailing Address - Street 1:935 THORN RUN RD STE W201
Mailing Address - Street 2:
Mailing Address - City:CORAOPOLIS
Mailing Address - State:PA
Mailing Address - Zip Code:15108-2861
Mailing Address - Country:US
Mailing Address - Phone:412-269-9665
Mailing Address - Fax:412-269-7985
Practice Address - Street 1:935 THORN RUN RD STE W201
Practice Address - Street 2:
Practice Address - City:CORAOPOLIS
Practice Address - State:PA
Practice Address - Zip Code:15108-2861
Practice Address - Country:US
Practice Address - Phone:412-269-9665
Practice Address - Fax:412-269-7985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036087L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty