MEDICARE: MRS. SUWAPANG PATTUMMADITH 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
1	207N00000X	Dermatology Physician	A32823	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	WA32823A	OTHER	CA	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821037581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUWAPANG PATTUMMADITH MD

Provider Business Mailing Address
First Line	:	1818 N ORANGE GROVE
Second Line	:	STE 104
City	:	POMONA
State	:	CA
Zip	:	91767-3028
Country	:	US
Telephone Number	:	909-592-2816
Fax Number	:

Provider Business Practice Location Address
First Line	:	1818 N ORANGE GROVE
Second Line	:	STE 104
City	:	POMONA
State	:	CA
Zip	:	91767-3028
Country	:	US
Telephone Number	:	909-592-2816
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	11/10/2008

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