Basic Information
Provider Information
NPI: 1801964218
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WU
FirstName: EUGENE
MiddleName: L
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2101 E JEFFERSON ST
Address2: KAISER PERMANENTE MEDICARE ENROLLMENT
City: ROCKVILLE
State: MD
PostalCode: 208524908
CountryCode: US
TelephoneNumber: 3018162424
FaxNumber:  
Practice Location
Address1: 1447 YORK RD
Address2: STE 100
City: TIMONIUM
State: MD
PostalCode: 210936107
CountryCode: US
TelephoneNumber: 4103395500
FaxNumber: 4103395620
Other Information
ProviderEnumerationDate: 12/01/2006
LastUpdateDate: 05/31/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/31/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000XD41984MDY Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 

No ID Information.


Home