Provider Demographics
NPI:1043219777
Name:WU, MAOXIN (MD, PHD)
Entity Type:Individual
Prefix:
First Name:MAOXIN
Middle Name:
Last Name:WU
Suffix:
Gender:F
Credentials:MD, PHD
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Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:STONY BROOK PATHOLOGISTS UFPC
Mailing Address - Street 2:SBUMC, BST L9, RM140
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8691
Mailing Address - Country:US
Mailing Address - Phone:631-444-3000
Mailing Address - Fax:631-444-3419
Practice Address - Street 1:STONY BROOK PATHOLOGISTS UFPC
Practice Address - Street 2:SBUMC, BST L9, RM 140
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8691
Practice Address - Country:US
Practice Address - Phone:631-444-3000
Practice Address - Fax:631-444-3419
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY213041207ZP0102X, 207ZC0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH34394Medicare UPIN
NY02Q701Medicare ID - Type Unspecified