Provider Demographics
NPI:1215999255
Name:MAMUYA, WILFRED (MD PHD)
Entity type:Individual
Prefix:
First Name:WILFRED
Middle Name:
Last Name:MAMUYA
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 LONGWOOD AVE
Mailing Address - Street 2:LOWN CARDIOVASCULAR CENTER
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5239
Mailing Address - Country:US
Mailing Address - Phone:617-732-1318
Mailing Address - Fax:617-734-5763
Practice Address - Street 1:21 LONGWOOD AVE
Practice Address - Street 2:LOWN CARDIOVASCULAR CENTER
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5239
Practice Address - Country:US
Practice Address - Phone:617-732-1318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA81392207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease