Provider Demographics
NPI:1013072636
Name:ADVANCED WOUND TECHNOLOGIES, INC.
Entity type:Organization
Organization Name:ADVANCED WOUND TECHNOLOGIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DOBBIN
Authorized Official - Middle Name:O
Authorized Official - Last Name:BOOKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:781-353-6439
Mailing Address - Street 1:1 ADAMS PLACE
Mailing Address - Street 2:859 WILLARD STREET, SUITE 400
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-7469
Mailing Address - Country:US
Mailing Address - Phone:781-353-6439
Mailing Address - Fax:866-231-5901
Practice Address - Street 1:20 LINDEN ST
Practice Address - Street 2:
Practice Address - City:ALLSTON
Practice Address - State:MA
Practice Address - Zip Code:02134-1711
Practice Address - Country:US
Practice Address - Phone:781-353-6439
Practice Address - Fax:866-231-5901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA8200479OtherEVERCARE-UHC PROVIDER #
MA1540297Medicaid
MA398754OtherBCBS PROVIDER NUMBER
MA4322510001Medicare NSC