Healthcare Provider Details

I. General information

NPI: 1013150796
Provider Name (Legal Business Name): RICHARD MAO WU M.D., M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: CHIEH MAO VU

II. Dates (important events)

Enumeration Date: 04/11/2009
Last Update Date: 04/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 S. 10TH STREET, MAIN BLDG STE 430
PHILADELPHIA PA
19107
US

IV. Provider business mailing address

404 S CROSKEY ST APT F
PHILADELPHIA PA
19146-1166
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-8900
  • Fax:
Mailing address:
  • Phone: 818-288-8832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number25MA09443100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: