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General NPI Number Information
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NPI Number | 1891807855
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Entity Type | Individual
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Provider Name | THAVORN LORUNGROCHANA M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 4649 NANNIE HELEN BURROUGHS AVE NE
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City | WASHINGTON
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State | DC
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Zip | 20019-3662
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Country | US
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Telephone | 202-398-4700
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Fax | 202-398-4701
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Provider Business Mailing Address
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Address Line | 12025 APPLE KNOLL CT
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City | NORTH POTOMAC
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State | MD
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Zip | 20878-2374
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Country | US
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Telephone | 301-840-9482
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Fax | 301-840-9482
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD7557
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License Number State | DC
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