Provider Demographics
NPI:1306891056
Name:PU, INGER-MARIE R (MD)
Entity type:Individual
Prefix:
First Name:INGER-MARIE
Middle Name:R
Last Name:PU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 ORNAC
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742
Mailing Address - Country:US
Mailing Address - Phone:978-369-1400
Mailing Address - Fax:978-287-3680
Practice Address - Street 1:133 ORNAC
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742
Practice Address - Country:US
Practice Address - Phone:978-369-1400
Practice Address - Fax:978-287-3680
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA78784208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ30901OtherBCBS MA
737748OtherTUFTS HLTH PLAN
206546OtherHARVARD PILGRIM HLTH PLAN
MA25876OtherFALLON
206546OtherHARVARD PILGRIM HLTH PLAN
MAJ30901Medicare ID - Type Unspecified