Healthcare Provider Details

I. General information

NPI: 1982691333
Provider Name (Legal Business Name): MARK P. WU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2033 MAIN ST
ATHOL MA
01331-3535
US

IV. Provider business mailing address

2033 MAIN ST
ATHOL MA
01331-3535
US

V. Phone/Fax

Practice location:
  • Phone: 978-249-3511
  • Fax: 978-249-7666
Mailing address:
  • Phone: 978-249-3511
  • Fax: 978-249-7666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number50555
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number50555
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number50555
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: