Healthcare Provider Details

I. General information

NPI: 1023003274
Provider Name (Legal Business Name): WINNY OU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 08/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 BRISTOL DR
SOUTH EASTON MA
02375-1100
US

IV. Provider business mailing address

21 BRISTOL DR
SOUTH EASTON MA
02375-1199
US

V. Phone/Fax

Practice location:
  • Phone: 508-565-7300
  • Fax: 508-565-7335
Mailing address:
  • Phone: 508-350-2350
  • Fax: 508-350-2318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number48641
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: