Provider Demographics
NPI:1598783094
Name:WU, RICHARD K (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:K
Last Name:WU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 CHESTNUT ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01199-1001
Mailing Address - Country:US
Mailing Address - Phone:413-794-5700
Mailing Address - Fax:
Practice Address - Street 1:424 STATE RD
Practice Address - Street 2:
Practice Address - City:SOUTH DEERFIELD
Practice Address - State:MA
Practice Address - Zip Code:01373-9605
Practice Address - Country:US
Practice Address - Phone:413-665-8517
Practice Address - Fax:413-665-8741
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA209003207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110235924OtherRAILROAD MEDICARE
1295040OtherFALLON COMM HEALTH PLAN
J24139OtherBLUE CROSS BLUE SHIELD
MA0135500Medicaid
0074947005OtherCIGNA
461848OtherTUFTS COMM HEALTH PLAN
H36812Medicare UPIN
696457OtherHARVARD PILGRIM
MAA32329Medicare PIN
753161OtherCONNECTICARE