# INTEGRATED WOUND CARE MARYLAND LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** INTEGRATED WOUND CARE MANAGEMENT MARYLAND LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154963056
- **Authorized official:** DIANE LUSAS MD (MEMBER)
- **Authorized official phone:** (732) 451-4318

## Contact information

- **Practice address:** 85 HOSPITAL RD, PRINCE FREDERICK, MD 20678-4018
- **Practice address phone:** (201) 870-1194
- **Mailing address:** 492C CEDAR LN STE 514, TEANECK, NJ 07666-1713

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/11/2019
- **Last updated:** 02/23/2022