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General NPI Number Information
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NPI Number | 1225693765
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Entity Type | Individual
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Provider Name | THET SU WIN MD PHD
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Gender | Female
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Dates
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Enumeration Date | 05/09/2019
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Last Update Date | 01/19/2026
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Provider Practice Location Address
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Address Line | 485 ARSENAL ST
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City | WATERTOWN
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State | MA
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Zip | 02472-5091
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Country | US
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Telephone | 617-492-3500
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Fax |
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Provider Business Mailing Address
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Address Line | 485 ARSENAL ST
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City | WATERTOWN
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State | MA
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Zip | 02472-5091
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | 1019979
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License Number State | MA
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