Healthcare Provider Details

I. General information

NPI: 1750692521
Provider Name (Legal Business Name): EKKARAT AKRAGORN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2010
Last Update Date: 11/16/2020
Certification Date: 11/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 GAINSBOROUGH SQ STE 100
CHESAPEAKE VA
23320-1706
US

IV. Provider business mailing address

PO BOX 11314
BELFAST ME
04915-4004
US

V. Phone/Fax

Practice location:
  • Phone: 757-410-2287
  • Fax: 757-410-7747
Mailing address:
  • Phone: 757-842-4481
  • Fax: 757-312-3135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101256022
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: