Provider Demographics
NPI:1801887997
Name:WEN, SHIH-TE (MD)
Entity type:Individual
Prefix:
First Name:SHIH-TE
Middle Name:
Last Name:WEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 HENRY GRAF ROAD
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950
Mailing Address - Country:US
Mailing Address - Phone:978-462-1110
Mailing Address - Fax:978-462-3889
Practice Address - Street 1:7 HENRY GRAF ROAD
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950
Practice Address - Country:US
Practice Address - Phone:978-462-1110
Practice Address - Fax:978-462-3889
Is Sole Proprietor?:No
Enumeration Date:2005-10-29
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA202871207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2128187Medicaid
NH30205892Medicaid
NHSX4074Medicare PIN
P00305452Medicare PIN
MA2128187Medicaid
MAA39498Medicare PIN