1417940883 NPI number — DR. PRAMUAN THIRASILPA MD

Table of content: DR. PRAMUAN THIRASILPA MD (NPI 1417940883)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417940883 NPI number — DR. PRAMUAN THIRASILPA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THIRASILPA
Provider First Name:
PRAMUAN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

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

NPI Number Information

NPI Number:
1417940883
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
948 EBERSOLE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FOSTORIA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44830-1413
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-435-8159
Provider Business Mailing Address Fax Number:
419-435-8150

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
948 EBERSOLE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOSTORIA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44830-1413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-435-8159
Provider Business Practice Location Address Fax Number:
419-435-8150
Provider Enumeration Date:
08/31/2005

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: 207Q00000X , with the licence number:  35034307 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208000000X , with the licence number: 35034307 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 02613 . This is a "PARAMOUNT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4239722 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010048936 . This is a "RR MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2221113 . This is a "CIGNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0000023395703 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0195435 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000130594 . This is a "ANTHEM BCBS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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