Individual
DR. KEVIN WAYNE SU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
725 ALBANY ST, SHAPIRO 5 & 6, BOSTON, MA 02118-2526
(617) 414-5951
(617) 414-9251
Mailing address
725 ALBANY ST, SHAPIRO 5 & 6, BOSTON, MA 02118-2526
(617) 414-5951
(617) 414-9251
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
277976
MA
208M00000X
Hospitalist Physician
277976
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
277976
MA STATE MEDICAL LICENSE
MA
Enumeration date
03/22/2016
Last updated
04/08/2019
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