Provider Demographics
NPI:1609909225
Name:TWATCHAI YAMCHARERN, M.D., P.C.
Entity Type:Organization
Organization Name:TWATCHAI YAMCHARERN, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TWATCHAI
Authorized Official - Middle Name:
Authorized Official - Last Name:YAMCHARERN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-272-1935
Mailing Address - Street 1:8244 E US HIGHWAY 36
Mailing Address - Street 2:SUITE 1230
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-9613
Mailing Address - Country:US
Mailing Address - Phone:317-272-1935
Mailing Address - Fax:317-272-1936
Practice Address - Street 1:8244 E US HIGHWAY 36
Practice Address - Street 2:SUITE 1230
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-9613
Practice Address - Country:US
Practice Address - Phone:317-272-1935
Practice Address - Fax:317-272-1936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01034715208200000X, 2082S0099X, 2082S0105X, 2086S0105X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and NeckGroup - Multi-Specialty
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Multi-Specialty
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the HandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN=========OtherTAX ID
IN=========OtherTAX ID
INB29578Medicare UPIN