Provider Demographics
NPI:1407094428
Name:PRACHAK T SIRIPRAKORN M.D. P.C.
Entity Type:Organization
Organization Name:PRACHAK T SIRIPRAKORN M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PRACHAK
Authorized Official - Middle Name:T
Authorized Official - Last Name:SIRIPRAKORN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-491-2179
Mailing Address - Street 1:1966 OPITZ BLVD
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3304
Mailing Address - Country:US
Mailing Address - Phone:703-491-2179
Mailing Address - Fax:703-491-4532
Practice Address - Street 1:1966 OPITZ BLVD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3304
Practice Address - Country:US
Practice Address - Phone:703-491-2179
Practice Address - Fax:703-491-4532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-29
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA438917OtherMEDICARE, CAMP HILL, PA