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NPI Code Detail

MEDICARE: PHUMPATTRA CHARIYAWONG MD

MEDICARE: PHUMPATTRA CHARIYAWONG MD
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
1207R00000XInternal Medicine PhysicianT3600TX
2207R00000XInternal Medicine PhysicianMD30158ME
3208M00000XHospitalist PhysicianMD30158ME

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1T3600OTHERTXTEXAS MEDICAL BOARD

General Provider Information

NPI Number : 1740665553
Entity Type Code : Individual
Provider Name (Legal Business Name) : PHUMPATTRA CHARIYAWONG MD
Provider Business Mailing Address
First Line : 22 BRAMHALL ST
Second Line :
City : PORTLAND
State : ME
Zip : 04102-3134
Country : US
Telephone Number : 207-662-4618
Fax Number : 207-662-6254
Provider Business Practice Location Address
First Line : 22 BRAMHALL ST
Second Line :
City : PORTLAND
State : ME
Zip : 04102-3134
Country : US
Telephone Number : 207-662-4618
Fax Number : 207-662-6254
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2015
Last Update Date : 03/05/2026

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Directions to “ PHUMPATTRA CHARIYAWONG MD” Practice Location

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