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NPI Code Detail

MEDICARE: DR. THET SU WIN MD PHD

MEDICARE: DR. THET SU WIN MD PHD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207ND0101XMOHS-Micrographic Surgery Physician1019979MA

General Provider Information

NPI Number : 1225693765
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. THET SU WIN MD PHD
Provider Business Mailing Address
First Line : 485 ARSENAL ST
Second Line :
City : WATERTOWN
State : MA
Zip : 02472-5091
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 485 ARSENAL ST
Second Line :
City : WATERTOWN
State : MA
Zip : 02472-5091
Country : US
Telephone Number : 617-492-3500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/09/2019
Last Update Date : 01/19/2026

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