Provider Demographics
NPI:1477766707
Name:APIVATANAGUL, PIYAPORN (MD)
Entity Type:Individual
Prefix:DR
First Name:PIYAPORN
Middle Name:
Last Name:APIVATANAGUL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4923 OGLETOWN STANTON RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2081
Mailing Address - Country:US
Mailing Address - Phone:302-225-0451
Mailing Address - Fax:302-225-0472
Practice Address - Street 1:4923 OGLETOWN STANTON RD
Practice Address - Street 2:SUITE 200
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2081
Practice Address - Country:US
Practice Address - Phone:302-225-0451
Practice Address - Fax:302-225-0472
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0073587207RN0300X
DEC1-0008359207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0143898Medicaid
DE1477766707Medicaid
NJ0143898Medicaid
MD242965ZAN8Medicare PIN