Provider Demographics
NPI:1649228370
Name:THEIN, WIN (MD)
Entity Type:Individual
Prefix:DR
First Name:WIN
Middle Name:
Last Name:THEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-3034
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:155 S ARCH ST
Practice Address - Street 2:STE B
Practice Address - City:MILTON
Practice Address - State:PA
Practice Address - Zip Code:17847-1136
Practice Address - Country:US
Practice Address - Phone:570-742-2655
Practice Address - Fax:570-742-2886
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD053274L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F91244Medicare UPIN
PA098435Medicare ID - Type Unspecified