Provider Demographics
NPI:1477639656
Name:YU, WANKIN J (MD)
Entity Type:Individual
Prefix:DR
First Name:WANKIN
Middle Name:J
Last Name:YU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:105 ERDMAN WAY
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453
Mailing Address - Country:US
Mailing Address - Phone:978-466-7800
Mailing Address - Fax:978-466-9333
Practice Address - Street 1:105 ERDMAN WAY
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453
Practice Address - Country:US
Practice Address - Phone:978-466-7800
Practice Address - Fax:978-466-9333
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA059212207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
110026291OtherRAILROAD MEDICARE
30299OtherHARVARD PILGRIM
J07107OtherBLUE CROSS
MA3033970Medicaid
5090OtherFALLON COMMUNITY
059212OtherTUFTS
30299OtherHARVARD PILGRIM
5090OtherFALLON COMMUNITY