Provider Demographics
NPI:1669407383
Name:WU, BARRY J (MD)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:J
Last Name:WU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 CHAPEL ST.
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511
Mailing Address - Country:US
Mailing Address - Phone:203-789-4044
Mailing Address - Fax:203-789-3007
Practice Address - Street 1:SAINT RAPHAEL FACULTY PHYSICIANS
Practice Address - Street 2:1450 CHAPEL ST
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511
Practice Address - Country:US
Practice Address - Phone:203-789-4044
Practice Address - Fax:203-789-3007
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT032513207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001325134Medicaid
CT110009012Medicare ID - Type Unspecified
F77816Medicare UPIN