Provider Demographics
NPI:1730258237
Name:TRUBOW, WENDIE (MD)
Entity type:Individual
Prefix:
First Name:WENDIE
Middle Name:
Last Name:TRUBOW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 WELLS AVE
Mailing Address - Street 2:FIVE JOURNEYS, SUITE 202
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-3344
Mailing Address - Country:US
Mailing Address - Phone:617-934-6400
Mailing Address - Fax:617-934-6401
Practice Address - Street 1:181 WELLS AVE
Practice Address - Street 2:FIVE JOURNEYS, SUITE 202
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459-3344
Practice Address - Country:US
Practice Address - Phone:617-934-6400
Practice Address - Fax:617-934-6401
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA220774207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA5945725OtherCIGNA HEALTH CARE
MA0033090OtherNEIGHBORHOOD HEALTH PLAN
MA469688OtherTUFTS HEALTH PLAN
MAAA16034OtherHARVARD PILGRIM HEALTH CA
MA2086522Medicaid
MAI17468Medicare UPIN
MAA37550Medicare ID - Type Unspecified