1780970467 NPI number — CHAWAT TONGMA M.D.

Table of content: CHAWAT TONGMA M.D. (NPI 1780970467)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780970467 NPI number — CHAWAT TONGMA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TONGMA
Provider First Name:
CHAWAT
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
THONGMA
Provider Other First Name:
THANAPORN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1780970467
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/15/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
155/2 MOO 6, SOI BANGKOK-NONTHABURI 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MUANG
Provider Business Mailing Address State Name:
NONTHABURI
Provider Business Mailing Address Postal Code:
11000
Provider Business Mailing Address Country Code:
TH
Provider Business Mailing Address Telephone Number:
662-527-2182
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
133 ROUTE 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEDEDO
Provider Business Practice Location Address State Name:
GU
Provider Business Practice Location Address Postal Code:
96929-6911
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
671-645-5500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/22/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  M-2026 , registered in the state of GU ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X , with the licence number: M-2026 , registered in the state of GU ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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