Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 25MA09443100 | NJ |
NPI | 1013150796 |
---|---|
Provider Name | Richard Mao Wu |
First Address | Philadelphia, PA 19146-1166 |
Second Address | Philadelphia, PA 19107 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2009 |
Last Update Date | 17/04/2015 |