Provider Demographics
NPI:1013087659
Name:PARKER, WENDY J (MD)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:J
Last Name:PARKER
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 1:30 GREYSTONE RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02030-2329
Mailing Address - Country:US
Mailing Address - Phone:774-893-4055
Mailing Address - Fax:
Practice Address - Street 1:307 W CENTRAL ST
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-3719
Practice Address - Country:US
Practice Address - Phone:508-820-8383
Practice Address - Fax:508-820-0250
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA57399207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3115348Medicaid
MA3115348Medicaid
MAJ11564Medicare ID - Type Unspecified