Provider Demographics
NPI:1053305938
Name:WRIGHT, ROBERT ENMETT (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ENMETT
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:746 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18510-1624
Mailing Address - Country:US
Mailing Address - Phone:570-343-2383
Mailing Address - Fax:570-963-6133
Practice Address - Street 1:640 MADISON AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-1607
Practice Address - Country:US
Practice Address - Phone:570-941-0630
Practice Address - Fax:570-941-0648
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD008864E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0663863Medicaid
PA0663863Medicaid
WR063468Medicare ID - Type Unspecified