Provider Demographics
NPI:1508858838
Name:RATANAPRSATPORN, SOMSRI (MD)
Entity Type:Individual
Prefix:MRS
First Name:SOMSRI
Middle Name:
Last Name:RATANAPRSATPORN
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 1:2108 LINDEN BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207-7411
Mailing Address - Country:US
Mailing Address - Phone:718-498-9898
Mailing Address - Fax:718-317-1892
Practice Address - Street 1:2108 LINDEN BLVD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-7411
Practice Address - Country:US
Practice Address - Phone:718-498-9898
Practice Address - Fax:718-317-1892
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-23
Last Update Date:2015-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY149948208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00701184Medicaid
NY00701184Medicaid
B79199Medicare UPIN