Provider Demographics
NPI:1073507273
Name:ONGKASUWAN, CHAWENG (MD)
Entity Type:Individual
Prefix:DR
First Name:CHAWENG
Middle Name:
Last Name:ONGKASUWAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 MAIDEN CHOICE LN
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-5943
Mailing Address - Country:US
Mailing Address - Phone:410-788-6738
Mailing Address - Fax:410-719-6910
Practice Address - Street 1:716 MAIDEN CHOICE LN
Practice Address - Street 2:SUITE 204
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21228-5943
Practice Address - Country:US
Practice Address - Phone:410-788-6738
Practice Address - Fax:410-719-6910
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0016205174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD36299OtherMAMSI/OPT/MDIPA PROV. ID
MD0129001OtherAETNA PROVIDER ID
MDB70058Medicare UPIN
MD0129001OtherAETNA PROVIDER ID