Healthcare Provider Details

I. General information

NPI: 1144209966
Provider Name (Legal Business Name): MANOP PITHUKPAKORN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CENTER DRIVE BLDG10 RM 10C103
BETHESDA MD
20892-0001
US

IV. Provider business mailing address

1703 E WEST HWY 508
SILVER SPRING MD
20910-3054
US

V. Phone/Fax

Practice location:
  • Phone: 301-435-6690
  • Fax:
Mailing address:
  • Phone: 301-585-0296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number36107409
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: