Healthcare Provider Details

I. General information

NPI: 1891744512
Provider Name (Legal Business Name): PANITDA TOOCHINDA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 10/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 DOUGLAS AVE
ALTAMONTE SPRINGS FL
32714-3336
US

IV. Provider business mailing address

264 DOUGLAS AVE
ALTAMONTE SPRINGS FL
32714-3336
US

V. Phone/Fax

Practice location:
  • Phone: 407-862-8377
  • Fax: 407-862-8883
Mailing address:
  • Phone: 407-862-8377
  • Fax: 407-862-8883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME 29981
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: