Provider Demographics
NPI:1225144678
Name:LANDMAN, WENDY B (MD)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:B
Last Name:LANDMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:75 FRANCIS ST
Mailing Address - Street 2:DEPARTMENT OF RADIOLOGY
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6110
Mailing Address - Country:US
Mailing Address - Phone:617-732-6506
Mailing Address - Fax:617-732-6336
Practice Address - Street 1:75 FRANCIS ST
Practice Address - Street 2:DEPARTMENT OF RADIOLOGY
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6110
Practice Address - Country:US
Practice Address - Phone:617-732-6506
Practice Address - Fax:617-732-6336
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA2026212085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAA63583OtherHPHC
MA0121428Medicaid
MAJ23255OtherBLUE CROSS/BLUE SHIELD
MA411043OtherTUFTS
MA0121428Medicaid
MAH31375Medicare UPIN