Provider Demographics
NPI:1710578323
Name:ADVANCED WOUND CENTER OF BURLINGAME PC
Entity type:Organization
Organization Name:ADVANCED WOUND CENTER OF BURLINGAME PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-287-0859
Mailing Address - Street 1:1838 EL CAMINO REAL STE 100
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-3105
Mailing Address - Country:US
Mailing Address - Phone:415-287-0859
Mailing Address - Fax:415-333-4031
Practice Address - Street 1:1838 EL CAMINO REAL STE 100
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3105
Practice Address - Country:US
Practice Address - Phone:415-287-0859
Practice Address - Fax:415-333-4031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty