Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0000X | Hematologist | MD068302L | PA |
NPI | 1134194632 |
---|---|
Provider Name | Dr. Panit Hirunsri Srivatana |
First Address | Sayre, PA 18840-1625 |
Second Address | Sayre, PA 18840-1625 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2006 |
Last Update Date | 27/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0019452110001 | (05) | PA |
02370318 | (05) | NY |
830008718 | RR MEDICARE PIN (01) | PA |
CC9269 | RR MEDICARE GROUP (01) | PA |
GU039841 | PA MEDICARE GROUP (01) | PA |
H78594 | (02) |