Provider Demographics
NPI:1568446151
Name:WU, JENNIFER S (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:S
Last Name:WU
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 1:663 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-3139
Mailing Address - Country:US
Mailing Address - Phone:781-665-1985
Mailing Address - Fax:781-665-0226
Practice Address - Street 1:663 MAIN ST
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-3139
Practice Address - Country:US
Practice Address - Phone:781-665-1985
Practice Address - Fax:781-665-0226
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-06
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA74505207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3085287Medicaid
130752OtherPILGRIM
074505OtherTUFTS
J11661OtherBLUE CROSS
130752OtherPILGRIM
130752OtherPILGRIM