| Marin Advanced Wound Center Pc | |
|
165 Rowland Way Ste 208 Novato CA 94945-5055 | |
| (415) 680-0871 | |
| (800) 808-1779 |
| Full Name | Marin Advanced Wound Center Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 165 Rowland Way Ste 208, Novato, California |
| Authorized Official Name and Position | Alexander Reyzelman (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 9253366062 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Marin Advanced Wound Center Pc 165 Rowland Way Ste 208 Novato CA 94945-5055 Ph: (415) 680-0871 | Marin Advanced Wound Center Pc 165 Rowland Way Ste 208 Novato CA 94945-5055 Ph: (415) 680-0871 |
| NPI Number | 1538652003 |
|---|---|
| Provider Enumeration Date | 06/10/2018 |
| Last Update Date | 12/17/2019 |
| Medicare PECOS PAC ID | 9537419346 |
|---|---|
| Medicare Enrollment ID | O20180828004232 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538652003 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | G59522 (California) | Primary |
| Provider Name | Alexander M Reyzelman |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1023192721 PECOS PAC ID: 9335228675 Enrollment ID: I20080512000367 |
| Provider Name | Mher Vartivarian |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1801117874 PECOS PAC ID: 8729234794 Enrollment ID: I20120807000237 |
| Provider Name | Anthony K Gordon |
|---|---|
| Provider Type | Practitioner - Other (physician) |
| Provider Identifiers | NPI Number: 1912968041 PECOS PAC ID: 1759362908 Enrollment ID: I20180604002881 |
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