Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | MD037438E | PA |
NPI | 1306912183 |
---|---|
Provider Name | Dr. Thongchai Vorasingha |
First Address | Philadelphia, PA 19148-3848 |
Second Address | Philadelphia, PA 19148-3848 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0057685001 | KEYSTONE HEALTH PLAN E. (01) | PA |
10288 | KEYSTONE MERCY HEALTH PLA (01) | PA |
B32188 | (02) | PA |