Provider Demographics
NPI:1972578185
Name:WADLEIGH, MARTHA (MD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:WADLEIGH
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 1:44 BINNEY ST
Mailing Address - Street 2:DANA 1B25
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115
Mailing Address - Country:US
Mailing Address - Phone:617-632-6685
Mailing Address - Fax:617-582-8202
Practice Address - Street 1:44 BINNEY ST
Practice Address - Street 2:DANA 1B25
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-632-6685
Practice Address - Fax:617-582-8202
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA209746207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
3600443OtherUNITED HEALTH CARE
MA2061956Medicaid
2069156OtherMASSHEALTH
J27416OtherINDEMNITY
9213265OtherCIGNA
AA13675OtherHPHC
J27416OtherHMO BLUE
209746OtherTUFTS
MAJ27416OtherMA BLUE CROSS BLUE SHIELD
3634389OtherAETNA US HEALTHCARE
J27416OtherBC ELECT
MA2061956Medicaid
J27416OtherBC ELECT