Provider Demographics
NPI:1144346552
Name:WYMAN, ROBERT PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:PAUL
Last Name:WYMAN
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 1:5 JARRETT CT
Mailing Address - Street 2:
Mailing Address - City:PRINCETON JUNCTION
Mailing Address - State:NJ
Mailing Address - Zip Code:08550-2215
Mailing Address - Country:US
Mailing Address - Phone:609-716-8872
Mailing Address - Fax:
Practice Address - Street 1:5 JARRETT CT
Practice Address - Street 2:
Practice Address - City:PRINCETON JUNCTION
Practice Address - State:NJ
Practice Address - Zip Code:08550-2215
Practice Address - Country:US
Practice Address - Phone:609-716-8872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06365100207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7073607Medicaid
NJ7073607Medicaid