| Nova Wound Care, P.c. | |
|
3700 Joseph Siewick Dr 303 Fairfax VA 22033-1744 | |
| (703) 664-8025 | |
| (703) 652-8470 |
| Full Name | Nova Wound Care, P.c. |
|---|---|
| Speciality | Family Medicine |
| Location | 3700 Joseph Siewick Dr, Fairfax, Virginia |
| Authorized Official Name and Position | Timothy R Lapham (OWNER/PRESIDENT) |
| Authorized Official Contact | 7038762710 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Nova Wound Care, P.c. 115 Beulah Rd Ne 100d Vienna VA 22180-4749 Ph: (703) 652-4251 | Nova Wound Care, P.c. 3700 Joseph Siewick Dr 303 Fairfax VA 22033-1744 Ph: (703) 664-8025 |
| NPI Number | 1063816155 |
|---|---|
| Provider Enumeration Date | 10/17/2014 |
| Last Update Date | 03/08/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063816155 | NPI | - | NPPES |
| 1255673943 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 0101240684 (Virginia) | Primary |
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