Healthcare Provider Details

I. General information

NPI: 1073507349
Provider Name (Legal Business Name): NARONG CHALOTHORN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 08/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 JAMES TRIMBLE BLVD
PAINTSVILLE KY
41240-1055
US

IV. Provider business mailing address

609 JAMES TRIMBLE BLVD
PAINTSVILLE KY
41240-1055
US

V. Phone/Fax

Practice location:
  • Phone: 606-789-6844
  • Fax: 606-789-4157
Mailing address:
  • Phone: 606-789-6844
  • Fax: 606-789-4157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number19367
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: