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General NPI Number Information
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NPI Number | 1982818332
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Entity Type | Organization
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Legal Business Name | DR SADTHA SURATTANONT
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Dates
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Enumeration Date | 05/09/2007
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Last Update Date | 06/13/2008
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Provider Practice Location Address
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Address Line | 55 NORTH BOLTON ST
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City | ROMNEY
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State | WV
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Zip | 26757-1980
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Country | US
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Telephone | 304-822-4241
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Fax | 304-822-3344
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Provider Business Mailing Address
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Address Line | PO BOX 1980 55 NORTH BOLTON ST
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City | ROMNEY
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State | WV
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Zip | 26757-1980
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Country | US
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Telephone | 303-822-4241
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Fax | 304-822-3344
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. SADTHA SURATTANONT
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Credential | MD
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Telephone | 304-822-4241
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 10426
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License Number State | WV
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