Individual
SAN WAN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
340 WOOD RD, BRAINTREE, MA 02184-2401
(781) 849-1111
(781) 794-2280
Mailing address
8 WILDFLOWER LN, WESTON, MA 02493-1167
(781) 647-9863
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
46315
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0156736
—
MA
01
—
01Y000581MA01
ANTHEM
—
01
—
0300380
UNITED HEALTHCARE
—
01
—
2430963
AETNA
—
01
—
401197
HARVARD PILGRIM HEALTHCAR
MA
01
—
713618
TUFTS HEALTH PLANS
MA
01
—
B20406102
CIGNA
—
01
—
B36040
BLUE CROSS BLUE SHIELD OF
MA
01
—
P00034200
RAILROAD MEDICARE
—
Enumeration date
02/04/2006
Last updated
07/08/2007
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