Healthcare Provider Details

I. General information

NPI: 1679707913
Provider Name (Legal Business Name): CHAYANIN VATCHARASIRITHAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2009
Last Update Date: 11/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 HEART DR. ECU PHYSICIANS
GREENVILLE NC
27834
US

IV. Provider business mailing address

P.O. BOX 751069 ECU PHYSICIANS
CHARLOTTE NC
28275-1069
US

V. Phone/Fax

Practice location:
  • Phone: 252-744-4400
  • Fax: 252-744-3987
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number2009-00186
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: