Provider Demographics
NPI:1922397918
Name:MULUGETA, WUDENEH MOLLA (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:WUDENEH
Middle Name:MOLLA
Last Name:MULUGETA
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:454 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-3034
Mailing Address - Country:US
Mailing Address - Phone:781-485-8222
Mailing Address - Fax:781-485-8220
Practice Address - Street 1:454 BROADWAY
Practice Address - Street 2:
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-3034
Practice Address - Country:US
Practice Address - Phone:781-485-8222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-31
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY278134207R00000X
390200000X
MA264420207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program