Tivitmahaisoon, Chanchai
Tivitmahaisoon, Chanchai is an individual health care provider with primary practice located at 20 Hospital Dr , Logan WV 25601-3452. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Tivitmahaisoon, Chanchai can be contacted via phone (304) 831-1254.Contact Information
Primary practice address
20 Hospital Dr
Logan WV 25601-3452
Phone: (304) 831-1254
Fax: (304) 831-1679
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | 11491 | West Virginia |
Profile Details
| NPI number | 1508820549 |
|---|---|
| LBN Legal business name | Tivitmahaisoon, Chanchai |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 14th, 2006 |
| Last updated | Jul 8th, 2007 - about 17 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 | 1508820549 | NPPES |
| West Virginia | MEDICAID | 0127820000 |
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