1912012022 NPI number — MR. PRAKORB ISARIYAWONGSE MD

Table of content: MR. PRAKORB ISARIYAWONGSE MD (NPI 1912012022)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912012022 NPI number — MR. PRAKORB ISARIYAWONGSE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ISARIYAWONGSE
Provider First Name:
PRAKORB
Provider Middle Name:
Provider Name Prefix Text:
MR.
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:
1912012022
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/17/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
129 SIMPSON ROAD
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
BROWNSVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15417
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-785-9696
Provider Business Mailing Address Fax Number:
724-785-7225

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
129 SIMPSON ROAD
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
BROWNSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-785-9696
Provider Business Practice Location Address Fax Number:
724-785-7225
Provider Enumeration Date:
08/20/2006

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: 208600000X , with the licence number:  MD033993L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: MD033993L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 202932 . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 60542 . This is a "UNISON" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7938474011 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 020031897 . This is a "PALMETTO MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0708585 . This is a "UNITED MINE WORKERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 129649 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0005869240004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 251310157 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 18700 . This is a "HEALTH AMERICA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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