Provider Demographics
NPI:1114984804
Name:WU, JUSTINA C (MD PHD)
Entity Type:Individual
Prefix:
First Name:JUSTINA
Middle Name:C
Last Name:WU
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
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Mailing Address - Street 1:111 CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-6002
Mailing Address - Country:US
Mailing Address - Phone:857-307-0896
Mailing Address - Fax:
Practice Address - Street 1:75 FRANCIS ST
Practice Address - Street 2:BRIGHAM AND WOMENS HOSPITAL CARDIOVASCULAR DIVISION
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6110
Practice Address - Country:US
Practice Address - Phone:857-307-1960
Practice Address - Fax:857-307-1944
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2012-04-30
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Provider Licenses
StateLicense IDTaxonomies
MA153760207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAH15313Medicare UPIN