Healthcare Provider Details

I. General information

NPI: 1235888769
Provider Name (Legal Business Name): JING WU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9501 OLD ANNAPOLIS RD STE 308
ELLICOTT CITY MD
21042-6337
US

IV. Provider business mailing address

9501 OLD ANNAPOLIS RD STE 308
ELLICOTT CITY MD
21042-6337
US

V. Phone/Fax

Practice location:
  • Phone: 301-621-6570
  • Fax: 844-606-5116
Mailing address:
  • Phone: 301-621-6570
  • Fax: 844-606-5116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0102353
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: