Basic Information
| Provider Information | |||||||||
| NPI: | 1770016677 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AFRA WOUND CARE ASSOCIATES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1717 COUNTRY CLUB DR | ||||||||
| Address2: | |||||||||
| City: | CHERRY HILL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080033448 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176863726 | ||||||||
| FaxNumber: | 8564282706 | ||||||||
| Practice Location | |||||||||
| Address1: | 773 SUMNEYTOWN PIKE | ||||||||
| Address2: | |||||||||
| City: | LANSDALE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194465301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8568666944 | ||||||||
| FaxNumber: | 8562435314 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2017 | ||||||||
| LastUpdateDate: | 08/03/2019 | ||||||||
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| AuthorizedOfficialLastName: | MANU | ||||||||
| AuthorizedOfficialFirstName: | KWASI | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO/FOUNDER | ||||||||
| AuthorizedOfficialTelephone: | 8566305088 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | MD440751 | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.