Provider Demographics
NPI:1447298054
Name:WIN, THAN THAN (MD)
Entity type:Individual
Prefix:
First Name:THAN
Middle Name:THAN
Last Name:WIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:874 PURCHASE ST
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-6232
Mailing Address - Country:US
Mailing Address - Phone:508-992-6553
Mailing Address - Fax:508-990-7558
Practice Address - Street 1:874 PURCHASE ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-6232
Practice Address - Country:US
Practice Address - Phone:508-992-6553
Practice Address - Fax:508-990-7558
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA150759207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0581897OtherAETNA
MA976774-01OtherNETWORK HEALTH
MA00451OtherSENIOR WHOLE HEALTH
MA402634OtherBCBSRIBLUE CHIP
MA00000024043OtherBMCHEALTHNET
MA20573-9OtherBCBSRI
MA402430OtherTUFTS HEALTH PLAN
MA3158489Medicaid
MA0400061OtherUNITED HEALTH PLAN
MA36690OtherCHILDRENS MEDICAL SEC
MA7774411-001OtherCIGNA PAL
MDB10441601OtherCIGNA
MA66036OtherHARVARD PILGRIM
MA0010055OtherNEIGHBORHOOD HEALTH PLAN
MAJ17739OtherBCBSMA
MA20573-9OtherBCBSRI
MA976774-01OtherNETWORK HEALTH