Provider Demographics
NPI:1023003274
Name:OU, WINNY (MD)
Entity Type:Individual
Prefix:
First Name:WINNY
Middle Name:
Last Name:OU
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 1:21 BRISTOL DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02375-1199
Mailing Address - Country:US
Mailing Address - Phone:508-350-2350
Mailing Address - Fax:508-350-2318
Practice Address - Street 1:21 BRISTOL DR
Practice Address - Street 2:
Practice Address - City:SOUTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02375-1100
Practice Address - Country:US
Practice Address - Phone:508-565-7300
Practice Address - Fax:508-565-7335
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA48641207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0190713Medicaid
MAJ01155Medicare ID - Type Unspecified
MA0190713Medicaid