Provider Demographics
NPI:1144773235
Name:ANANWORANICH, JINTANAT (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:JINTANAT
Middle Name:
Last Name:ANANWORANICH
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6720A ROCKLEDGE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-1892
Mailing Address - Country:US
Mailing Address - Phone:301-500-3949
Mailing Address - Fax:301-500-3666
Practice Address - Street 1:6720A ROCKLEDGE DR STE 400
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-1892
Practice Address - Country:US
Practice Address - Phone:301-500-3949
Practice Address - Fax:301-500-3666
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDD0080842174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist