Provider Demographics
NPI:1235167859
Name:WU, MELISSA (MD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:WU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 PROSPECT STREET
Mailing Address - Street 2:PO BOX 2014
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03061
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8 PROSPECT STREET
Practice Address - Street 2:SOUTHERN NEW HAMPSHIRE MEDICAL CENTER
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03061
Practice Address - Country:US
Practice Address - Phone:603-577-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD53344207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD020400500Medicaid
MDG68801Medicare UPIN
MDS806582VMedicare ID - Type Unspecified