Provider Demographics
NPI:1801088596
Name:WU, ROGER DONALD (MD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:DONALD
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 1:100 WAYLAND RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19807-2530
Mailing Address - Country:US
Mailing Address - Phone:570-906-0763
Mailing Address - Fax:
Practice Address - Street 1:137 W HIGH ST
Practice Address - Street 2:SUITE 2B
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-8600
Practice Address - Country:US
Practice Address - Phone:410-398-8888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-16
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT191250207R00000X
DEC1-0013600207RG0100X
MDD0075162282N00000X
MDD75162207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD282910Y2BOtherMEDICARE MARYLAND