Provider Demographics
NPI:1790713824
Name:WU, ROBERT H (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:H
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 1:65 HARRISON AVE STE 308
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1924
Mailing Address - Country:US
Mailing Address - Phone:617-338-9889
Mailing Address - Fax:617-618-3001
Practice Address - Street 1:65 HARRISON AVE STE 308
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1924
Practice Address - Country:US
Practice Address - Phone:617-338-9889
Practice Address - Fax:617-618-3001
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA79947207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAF84516Medicare UPIN