OrganizationNova Wound Care, P.C.(<Unavail>)Family MedicineAllopathic & Osteopathic PhysiciansPractice Address3700 Joseph Siewick Dr, 303, Fairfax, VA 22033-1744(703) 664-8025(703) 652-4251PECOS EnrollmentBased on the most recent information from CMS, provider Nova Wound Care, P.C. does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1063816155Provider TypeOrganizationFull NameNova Wound Care, P.C.Other Name<Unavail>SubpartNoEnumeration Date10/17/2014Last Updated3/8/2019Contact InformationPractice LocationPractice Address3700 Joseph Siewick Dr, 303, Fairfax, VA 22033-1744Phone(703) 664-8025Fax(703) 652-8470Mailing LocationMailing Address115 Beulah Rd NE, 100d, Vienna, VA 22180-4749Phone(703) 652-4251Fax(703) 652-8470Authorized OfficialNameLapham, Timothy R (Owner/President)Phone(703) 876-2710Provider TaxonomiesCodeDescriptionLicenseCode207Q00000XPrimaryDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicense0101240684VirginiaProvider IdentifiersIDDescriptionIssuerID1255673943DescriptionMedicaidIssuerUnlistedVirginia