Provider Demographics
NPI:1265404594
Name:WU, CATHERINE CHANGHONG (DPM)
Entity type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:CHANGHONG
Last Name:WU
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ORR SQUARE
Mailing Address - Street 2:#C
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-3200
Mailing Address - Country:US
Mailing Address - Phone:781-289-2144
Mailing Address - Fax:781-289-2167
Practice Address - Street 1:1 ORR SQUARE
Practice Address - Street 2:#C
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-3200
Practice Address - Country:US
Practice Address - Phone:781-289-2144
Practice Address - Fax:781-289-2167
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPD2141213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0316784Medicaid
MA333434OtherHARVARD PILGRAM
MAY71068OtherBLUE CROSS BLUE SHIELD
MA0316784Medicaid
Y75078Medicare ID - Type Unspecified
MA4885330001Medicare NSC