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NPI Code Detail

MEDICARE: DR. WITTAWAT KASAYAPANAND M.D.

MEDICARE: DR. WITTAWAT KASAYAPANAND M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0804XChild & Adolescent Psychiatry PhysicianMD071545LPA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MD071545LOTHERPAPHYSICIAN LICENSE

General Provider Information

NPI Number : 1225061880
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. WITTAWAT KASAYAPANAND M.D.
Provider Business Mailing Address
First Line : 29 SAND ST
Second Line :
City : PITTSTON
State : PA
Zip : 18640-2609
Country : US
Telephone Number : 570-332-5348
Fax Number :
Provider Business Practice Location Address
First Line : 335 S FRANKLIN ST
Second Line :
City : WILKES BARRE
State : PA
Zip : 18702-3808
Country : US
Telephone Number : 570-825-6425
Fax Number : 570-829-3337
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2006
Last Update Date : 09/26/2007

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