Healthcare Provider Details

I. General information

NPI: 1801088596
Provider Name (Legal Business Name): ROGER DONALD WU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2007
Last Update Date: 12/02/2021
Certification Date: 12/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 W HIGH ST SUITE 2B
ELKTON MD
21921-8600
US

IV. Provider business mailing address

100 WAYLAND RD
WILMINGTON DE
19807-2530
US

V. Phone/Fax

Practice location:
  • Phone: 410-398-8888
  • Fax:
Mailing address:
  • Phone: 570-906-0763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberD0075162
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMT191250
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberC1-0013600
License Number StateDE
# 4
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberD75162
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: