Provider Demographics
NPI:1508856311
Name:WRIGHT, DOUGLAS ELLIS (MD PHD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:ELLIS
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:MD PHD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:GRB 740 BIGELOW TEACHING SERVICE- INPATIENT
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-726-2862
Practice Address - Fax:617-724-7441
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2014-11-18
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Provider Licenses
StateLicense IDTaxonomies
MA225472207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ29017OtherBCBS MA
MA2107490Medicaid
MA462226OtherTUFTS HEALTH PLAN
MA2107490Medicaid
I35201Medicare UPIN