Phoncharoensri, Dittana

Phoncharoensri, Dittana is an individual health care provider with primary practice located at 152 E Kinderton Way Ste 101 , Bermuda Run NC 27006-7351. He recently has only one registered license in Allopathic & Osteopathic Physicians / Sleep Medicine, which is considered as his primary health care specialty. Phoncharoensri, Dittana can be contacted via phone (336) 893-3180.

Contact Information

Primary practice address
152 E Kinderton Way Ste 101 Bermuda Run NC 27006-7351
Phone: (336) 893-3180
Fax: (336) 893-3189
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Sleep Medicine 2084S0012X 201300784 North Carolina

Profile Details

NPI number 1750585170
LBN Legal business name Phoncharoensri, Dittana
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 11th, 2007
Last updated Oct 25th, 2020 - about 4 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1750585170 NPPES
North Carolina MEDICAID 1750585170

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