Provider Demographics
NPI:1558522565
Name:SONGDEJ, NATTHAPOL (MD)
Entity Type:Individual
Prefix:
First Name:NATTHAPOL
Middle Name:
Last Name:SONGDEJ
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:PO BOX 858
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-0858
Mailing Address - Country:US
Mailing Address - Phone:800-243-1455
Mailing Address - Fax:
Practice Address - Street 1:500 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2360
Practice Address - Country:US
Practice Address - Phone:717-531-8401
Practice Address - Fax:717-531-0647
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-23
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILP01493208000000X
PAMD445551207RH0000X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology