Healthcare Provider Details

I. General information

NPI: 1033114996
Provider Name (Legal Business Name): PIYAPONG VONGKOVIT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 06/28/2021
Certification Date: 06/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 2ND ST NE
WASHINGTON DC
20002-8100
US

IV. Provider business mailing address

7811 FOX GATE CT
BETHESDA MD
20817-4100
US

V. Phone/Fax

Practice location:
  • Phone: 202-346-3700
  • Fax: 202-346-3702
Mailing address:
  • Phone: 202-346-3700
  • Fax: 202-346-3702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number0101244938
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberD68503
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD038146
License Number StateDC
# 4
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number36611
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: