Lucktong, Tananchai A
Lucktong, Tananchai A is an individual health care provider with primary practice located at 3 Riverside Circle , Roanoke VA 24016. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Lucktong, Tananchai A can be contacted via phone (540) 224-5170.Contact Information
Primary practice address
3 Riverside Circle
Roanoke VA 24016
Phone: (540) 224-5170
Fax: (540) 983-8212
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | 0101-232309 | Virginia |
Profile Details
| NPI number | 1578526067 |
|---|---|
| LBN Legal business name | Lucktong, Tananchai A |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 7th, 2006 |
| Last updated | Aug 12th, 2011 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1578526067 | NPPES |
| Virginia | MEDICAID | 7304480 | |
| Virginia | MEDICAID | 010039762 |
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