# REGENWELL WOUND SPECIALTY GROUP - CENTRAL MD, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194540484
- **Authorized official:** VIVIAN TAN NP (OWNER)
- **Authorized official phone:** (443) 983-7125

## Contact information

- **Practice address:** 100 WEST RD STE 300, TOWSON, MD 21204-2370
- **Practice address phone:** (240) 203-7988
- **Practice address fax:** (240) 203-7988
- **Mailing address:** 100 WEST RD STE 300, TOWSON, MD 21204-2370
- **Mailing address phone:** (240) 203-7988

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/20/2024
- **Last updated:** 11/20/2024