Healthcare Provider Details

I. General information

NPI: 1457318180
Provider Name (Legal Business Name): CHRISTINE WU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 03/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

834 CHESTNUT ST SUITE T-171
PHILADELPHIA PA
19107-5127
US

IV. Provider business mailing address

834 CHESTNUT ST SUITE T-171
PHILADELPHIA PA
19107-5127
US

V. Phone/Fax

Practice location:
  • Phone: 215-503-2565
  • Fax: 215-503-2564
Mailing address:
  • Phone: 215-503-2565
  • Fax: 215-503-2564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMD042446E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: